Skip to main content
SpringerLink
Log in

Präklinische Intubation bei Trauma

Ergebnisse einer systematischen Literaturanalyse

Prehospital intubation in trauma. Results of a systematic analysis of literature

  • Leitthema
  • Published:
Notfall + Rettungsmedizin Aims and scope Submit manuscript

Zusammenfassung

Die orotracheale Intubation gilt als „Goldstandard“ zur Sicherung der Atemwege und Sicherstellung der Ventilation. Ihre Anwendung beim schwer verletzten Patienten in der Präklinik unterliegt jedoch aufgrund spezieller Gegebenheiten des verletzten Patienten selbst sowie der Rahmenbedingungen der Rettungssituation besonderen Umständen. So muss bei entsprechendem Verletzungsmechanismus stets eine Halswirbelsäulenverletzung angenommen und die Stabilisierung in der Achse angestrebt werden. Dennoch ist die Intubation präklinisch mit einer hohen Erfolgsquote durchführbar. Risiken können durch Komplikationen der meist notwendigen Narkoseeinleitung und eine Verlängerung der präklinischen Verweildauer auftreten. Da Notfallpatienten prinzipiell als „nicht-nüchtern“ gelten müssen, ist die Gefahr einer Aspiration deutlich erhöht. Eine eindeutige Indikation zur präklinischen Intubation besteht bei Atemwegsverlegung, gefährdeten Atemwegen (z. B. bei Blutungen im Nasen-Rachen-Raum, Bewusstlosigkeit), Apnoe oder einer Hypoxämie, die durch Sauerstoffgabe allein nicht beherrschbar ist. Eine (prophylaktische oder Schutz-) Intubation allein aufgrund von bestimmten Verletzungen (z. B. Schädel-Hirn-Trauma ohne Bewusstlosigkeit, Thoraxtrauma, multiple Frakturen) ohne gestörte Vitalfunktionen ist nicht generell indiziert. Besondere Umstände der Rettung und des Transports (lange Transportzeit/Hubschraubertransport) können hier jedoch eine Intubation rechtfertigen.

Abstract

Orotracheal intubation remains the gold standard of securing a definitive airway in trauma care. When performed in the prehospital environment special attention has to be paid to cervical spine protection, the risk of aspiration and possible side-effects of analgesia and sedation. Intubation is clearly indicated in case of airway obstruction, impending loss of the airway, apnea and severe hypoxia not otherwise controlled. Prophylactic intubation based on specific injuries (head injury without unconsciousness, chest trauma, multiple fractures) alone without deterioration of vital functions is not generally indicated. Intubation may be considered in order to address special conditions of rescue and air-transport.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Literatur

  1. Adnet F, Jouriles NJ, LeToumelin P et al. (1998) Survey of out-of-hospital emergency intubations in the French prehospital medical system: a multicenter study. Ann Emerg Med 32: 454–460

    Article  PubMed  CAS  Google Scholar 

  2. American College of Surgeons Committee on Trauma (2004) ATLS Student Course Manual. American College of Surgeons, Chicago, IL

  3. Aufmkolk M, Ruchholtz S, Hering M et al. (2003) Wertigkeit der subjektiven Einschätzung der Thoraxverletzungsschwere durch den Notarzt. Unfallchirurg 106: 746–753

    Article  PubMed  CAS  Google Scholar 

  4. Bernard S, Smith K, Foster S et al. (2002) The use of rapid sequence intubation by ambulance paramedics for patients with severe head injury. Emerg Med (Fremantle) 14: 406–411

    Article  Google Scholar 

  5. Bochicchio G (2003) Endotracheal intubation in the field does not improve outcome in trauma patients who present without an acutely lethal traumatic brain injury. J Trauma 54: 307–311

    PubMed  Google Scholar 

  6. Bunn F, Kwan I, Roberts I, Wentz R, WHO Pre-hospital Care Steering Committee (2001) Effectiveness of pre-hospital trauma care. Cochrane Injuries Group

  7. Butler KH, Clyne B (2003) Management of the difficult airway: alternative airway techniques and adjuncts. Emerg Med Clin North Am 21: 259–289

    Article  PubMed  Google Scholar 

  8. Chesnut RM (1997) Avoidance of hypotension: conditio sine qua non of successful severe head-injury management. J Trauma 42: S4–S9

    PubMed  CAS  Google Scholar 

  9. Chesnut RM, Marshall LF, Klauber MR et al. (1993) The role of secondary brain injury in determining outcome from severe head injury. J Trauma 34: 216–222

    PubMed  CAS  Google Scholar 

  10. Cooper A, DiScala C, Foltin G et al. (2001) Prehospital endotracheal intubation for severe head injury in children: a reappraisal. Semin Pediatr Surg 10: 3–6

    Article  PubMed  CAS  Google Scholar 

  11. David JS, Cresta MP, Souab A et al. (1999) [Severe head injuries: effects of pre-hospital mechanical ventilation on capnia]. Ann Fr Anesth Reanim 18: 398–402

    PubMed  CAS  Google Scholar 

  12. Davis DP, Dunford JV, Ochs M, Hoyt DB (2003) Inadvertent hyperventilation following paramedic rapid sequence intubation of severely head-injured patients. Acad Emerg Med 10: 446

    Article  Google Scholar 

  13. Davis DP, Hoyt DB, Ochs M et al. (2003) The effect of paramedic rapid sequence intubation on outcome in patients with severe traumatic brain injury. J Trauma 54: 444–453

    PubMed  Google Scholar 

  14. Davis DP, Hoyt DB, Ochs M et al. (2003) The effect of paramedic rapid sequence intubation on outcome in severe traumatic brain injury. Acad Emerg Med 10: 446–447

    Article  Google Scholar 

  15. Davis DP, Kimbro TA, Vilke GM (2001) The use of midazolam for prehospital rapid-sequence intubation may be associated with a dose-related increase in hypotension. Prehosp Emerg Care 5: 163–168

    Article  PubMed  CAS  Google Scholar 

  16. Davis DP, Ochs M, Hoyt D, Bailey D (2003) Paramedic-administered neuromuscular blockade improves prehospital intubation success in severely head-injured patients. J Trauma 55: 713–719

    PubMed  CAS  Google Scholar 

  17. Dunham CM, Barraco RD, Clark DE et al. (2003) Guidelines for emergency tracheal intubation immediately after traumatic injury. J Trauma 55: 162–179

    PubMed  Google Scholar 

  18. EAST Practice Management Guidelines Work Group (2001) Guidelines for emergency tracheal intubation following traumatic injury.

  19. Eckstein M, Chan L, Schneir A, Palmer R (2000) Effect of prehospital advanced life support on outcomes of major trauma patients. J Trauma 48: 643–648

    PubMed  CAS  Google Scholar 

  20. Falk JL, Sayre MR (1999) Confirmation of airway placement. Prehosp Emerg Care 3: 273–278

    Article  PubMed  CAS  Google Scholar 

  21. Frankel H, Rozycki G, Champion H et al. (1997) The use of TRISS methodology to validate prehospital intubation by urban EMS providers. Am J Emerg Med 15: 630–632

    Article  PubMed  CAS  Google Scholar 

  22. Gausche M, Lewis RJ, Stratton SJ et al. (2000) Effect of out-of-hospital pediatric endotracheal intubation on survival and neurological outcome: a controlled clinical trial. JAMA 283: 783–790

    Article  PubMed  CAS  Google Scholar 

  23. Helm M, Hauke J, Lampl L (2002) A prospective study of the quality of pre-hospital emergency ventilation in patients with severe head injury. Br J Anaesth 88: 345–349

    Article  PubMed  CAS  Google Scholar 

  24. Jeremitsky E, Omert L, Dunham CM et al. (2003) Harbingers of poor outcome the day after severe brain injury: hypothermia, hypoxia, and hypoperfusion. J Trauma 54: 312–319

    PubMed  Google Scholar 

  25. Katz SH, Falk JL (2001) Misplaced endotracheal tubes by paramedics in an urban emergency medical services system. Ann Emerg Med 37: 32–37

    Article  PubMed  CAS  Google Scholar 

  26. Kelly A (2001) Does advanced airway management in the field by paramedics improve patient outcome? A review of the literature. Prehosp Immediate Care 5: 16–18

    Google Scholar 

  27. Leitlinienkommission der Deutschen Gesellschaft für Unfallchirurgie (2001) Polytrauma. Leitlinie für die Unfallchirurgische Diagnostik und Therapie. Unfallchirurg 104: 909–912

    Google Scholar 

  28. Manley G, Knudson MM, Morabito D et al. (2001) Hypotension, hypoxia, and head injury: frequency, duration, and consequences. Arch Surg 136: 1118–1123

    Article  PubMed  CAS  Google Scholar 

  29. Murray JA, Demetriades D, Berne TV et al. (2000) Prehospital intubation in patients with severe head injury. J Trauma 49: 1065–1070

    PubMed  CAS  Google Scholar 

  30. Nolan JP, Deakin CD, Soar J et al. (2005) European Resuscitation Council guidelines for resuscitation 2005. Section 4. Adult advanced life support. Resuscitation (Suppl 1) 67: S39–S86

  31. Ochs M, Davis D, Hoyt D et al. (2002) Paramedic-performed rapid sequence intubation of patients with severe head injuries. Ann Emerg Med 40: 159–167

    Article  PubMed  Google Scholar 

  32. Pace SA, Fuller FP (2000) Out-of-hospital succinylcholine-assisted endotracheal intubation by paramedics. Ann Emerg Med 35: 568–572

    Article  PubMed  CAS  Google Scholar 

  33. Pelucio M, Halligan L, Dhindsa H (1997) Out-of-hospital experience with the syringe esophageal detector device. Acad Emerg Med 4: 563–568

    PubMed  CAS  Google Scholar 

  34. Rivara FP, Maier RV, Mueller BA et al. (1989) Evaluation of potentially preventable deaths among pedestrian and bicyclist fatalities. JAMA 261: 566–570

    Article  PubMed  CAS  Google Scholar 

  35. Ruchholtz S, Waydhas C (2002) Prehospital intubation in severe thoracic trauma without respiratory insufficiency: a matched-pair analysis based on the trauma registry of the german trauma society. J Trauma 52: 879–886

    PubMed  Google Scholar 

  36. Shafi S, Gentilello L (2005) Pre-hospital endotracheal intubation and positive pressure ventilation is associated with hypotension and decreased survival in hypovolemic trauma patients: an analysis of the National Trauma Data Bank. J Trauma 59: 1140–1145

    Article  PubMed  Google Scholar 

  37. Sing RF, Rotondo MF, Zonies DH et al. (1998) Rapid sequence induction for intubation by an aeromedical transport team: a critical analysis. Am J Emerg Med 16: 598–602

    Article  PubMed  CAS  Google Scholar 

  38. Sloane C, Vilke GM, Chan TC et al. (2000) Rapid sequence intubation in the field versus hospital in trauma patients. J Emerg Med 19: 259–264

    Article  PubMed  CAS  Google Scholar 

  39. Stocchetti N, Furlan A, Volta F (1996) Hypoxemia and arterial hypotension at the accident scene in head injury. J Trauma 40: 764–767

    Article  PubMed  CAS  Google Scholar 

  40. Stockinger ZT, McSwain NE Jr (2004) Prehospital endotracheal intubation for trauma does not improve survival over bag-valve-mask ventilation. J Trauma 56: 531–536

    PubMed  Google Scholar 

  41. Suominen P, Baillie C, Kivioja A et al. (2000) Intubation and survival in severe paediatric blunt head injury. Eur J Emerg Med 7: 3–7

    PubMed  CAS  Google Scholar 

  42. Timmermann A, Russo SG, Eich Christian et al. (2997) The out-of-hospital esophageal and endobronchial intubations performed by emergency physicians. Anesth Analg 104: 619–623

    Article  Google Scholar 

  43. Trupka A, Waydhas C (1995) Der Einfluß der Frühintubation auf die Reduktion des posttraumatischen Organversagens. Unfallchirurg 98: 111–117

    PubMed  CAS  Google Scholar 

  44. Ufberg JW, Bushra JS, Karras DJ et al. (2005) Aspiration of gastric contents: association with prehospital intubation. Am J Emerg Med 23: 379–382

    Article  PubMed  Google Scholar 

  45. Wang HE, Sweeney TA, O’Connor RE, Rubinstein H (2001) Failed prehospital intubations: an analysis of emergency department courses and outcomes. Prehosp Emerg Care 5: 134–141

    Article  PubMed  CAS  Google Scholar 

  46. Wayne MA, Friedland E (1999) Prehospital use of succinylcholine: a 20-year review. Prehosp Emerg Care 3: 107–109

    Article  PubMed  CAS  Google Scholar 

  47. Winchell RJ, Hoyt DB (1997) Endotracheal intubation in the field improves survival in patients with severe head injury. Trauma Research and Education Foundation of San Diego. Arch Surg 132: 592–597

    PubMed  CAS  Google Scholar 

Download references

Interessenkonflikt

Der korrespondierende Autor gibt an, dass kein Interessenkonflikt besteht.

Author information

Authors and Affiliations

  1. Klinik für Unfallchirurgie, Universitätsklinikum Essen, Hufelandstraße 55, 45122, Essen, Deutschland

    M. Fischbacher

  2. Klinik für Unfall- und Wiederherstellungschirurgie, Unfallkrankenhaus Berlin, Berlin, Deutschland

    G. Matthes

  3. Klinik für Unfall- und Wiederherstellungschirurgie, Berufsgenossenschaftliche Unfallklinik Ludwigshafen, Ludwigshafen, Deutschland

    C. Wölfl

  4. Institut für Forschung in der operativen Medizin, Universität Witten-Herdecke, Witten, Deutschland

    S. Sauerland

Authors
  1. M. Fischbacher
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. G. Matthes
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. C. Wölfl
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Sauerland
    View author publications

    You can also search for this author in PubMed Google Scholar

Consortia

AG Notfallmedizin der Deutschen Gesellschaft für Unfallchirurgie

Corresponding author

Correspondence to M. Fischbacher.

Rights and permissions

Reprints and permissions

About this article

Cite this article

Fischbacher, M., Matthes, G., Wölfl, C. et al. Präklinische Intubation bei Trauma. Notfall Rettungsmed 10, 494–499 (2007). https://doi.org/10.1007/s10049-007-0970-z

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10049-007-0970-z

Schlüsselwörter

Keywords

Search

Navigation