Blutstillungsmaßnahmen in der Notfallaufnahme – Schritt für Schritt

Infolge terroristischer Anschläge in Europa in der letzten Dekade mit einer Zunahme penetrierender Verletzungen auch der Extremitäten wurden Tourniquets (TQ) wieder in den Rettungsdienst eingeführt und die Rettungsdienstmitarbeiter in der Anwendung geschult. Inzwischen gelten TQ als lebensrettende Standardbehandlung, insbesondere wenn sie so schnell wie möglich nach einer Verletzung eingesetzt werden [1] [2] [3] [4] [5] [6].

• Literatur

• 1 Beekley AC, Sebesta JA, Blackbourne LH. et al. 31st Combat Support Hospital Research Group. Prehospital tourniquet use in Operation Iraqi Freedom: effect on hemorrhage control and outcomes. J Trauma 2008; 64: S28-S37
• 2 Kragh Jr JF, Walters TJ, Baer DG. et al. Survival with emergency tourniquet use to stop bleeding in major limb trauma. Ann Surg 2009; 249: 1-7
• 3 Eastridge BJ, Mabry RL, Seguin P. et al. Death on the battlefield (2001–2011): implications for the future of combat casualty care. J Trauma Acute Care Surg 2012; 73: S431-S437
• 4 Butler jr FK. TCCC Updates: Two Decades of Saving Lives on the Battlefield: Tactical Combat Casualty Care Turns 20. J Spec Oper Med 2017; 17: 166-172
• 5 Kragh jr JF, O’Neill ML, Beebe DF. et al. Survey of the indications for use of emergency tourniquets. J Spec Oper Med 2011; 11: 30-38
• 6 Kragh jr JF, Swan KG, Smith DC. et al. Historical review of emergency tourniquet use to stop bleeding. Am J Surg 2012; 203: 242-252
• 7 Hossfeld B, Josse F, Kulla M. et al. Handlungsempfehlung: Prähospitale Anwendung von Tourniquets. Anästh Intensiv 2016; 57: 698-704
• 8 Scerbo MH, Mumm JP, Gates K. et al. Safety and Appropriateness of Tourniquets in 105 Civilians. Prehosp Emerg Care 2016; 20: 712-722
• 9 Hodgetts TJ, Mahoney PF, Russell MQ. et al. ABC to <C>ABC: redefining the military trauma paradigm. Emerg Med J 2006; 23: 745
• 10 Stevens RA, Baker MS, Zubach OB. et al. Misuse of Tourniquets in Ukraine may be Costing More Lives and Limbs Than They Save. Mil Med 2024; 189: 304-308
• 11 Butler F, Holcomb JB, Dorlac W. et al. Who needs a tourniquet? And who does not? Lessons learned from a review of tourniquet use in the Russo-Ukrainian war. J Trauma Acute Care Surg 2024; 97: S45-S54
• 12 Shackelford SA, Butler jr FK, Kragh jr JF. et al. Optimizing the Use of Limb Tourniquets in Tactical Combat Casualty Care: TCCC Guidelines Change 14-02. J Spec Oper Med 2015; 15: 17-31
• 13 Poltermann S, Koch S. Tourniquet – Schritt für Schritt. retten! 2021; 10: 369-371
• 14 Lechner R, Hossfeld B, Leitner M. et al. Wundtamponade mit Hämostyptika – Schritt für Schritt. Notfallmedizin up2date 2023; 18: 367-372
• 15 Lechner R, Helm M, Mueller M. et al. Efficacy of Hemostatic Agents in Humans With Rotational Thromboelastometry: An in-vitro Study. Mil Med 2016; 181: 907-912
• 16 Lechner R, Hanke K, Schmid A. et al. Hemostatics in patients with inhibited coagulation (HEMPIC) – a viscoelastic in-vitro analysis. Transfusion 2023; 63: S159-S167
• 17 Littlejohn LF, Devlin JJ, Kircher SS. et al. Comparison of Celox-A, ChitoFlex, WoundStat, and combat gauze hemostatic agents versus standard gauze dressing in control of hemorrhage in a swine model of penetrating trauma. Acad Emerg Med 2011; 18: 340-350
• 18 Watters JM, Van PY, Hamilton GJ. et al. Advanced hemostatic dressings are not superior to gauze for care under fire scenarios. J Trauma 2011; 70: 1413-1419
• 19 Kunio NR, Riha GM, Watson KM. et al. Chitosan based advanced hemostatic dressing is associated with decreased blood loss in a swine uncontrolled hemorrhage model. Am J Surg 2013; 205: 505-510
• 20 Kragh JF, Steinbaugh J, Parsons DL. et al. A manikin model for study of wound-packing interventions to control out-of-hospital hemorrhage. Am J Emerg Med 2014; 32: 1130-1131
• 21 Latuska KM, Graf RL, Zwislewski A. et al. Stop the Bleed Training Improves Knowledge, Skills, and Confidence Among School Nurses. J Contin Educ Nurs 2019; 50: 501-507
• 22 Chou TC, Fu E, Wu CJ. et al. Chitosan enhances platelet adhesion and aggregation. Biochem Biophys Res Commun 2003; 302: 480-483
• 23 Peng HT. Hemostatic agents for prehospital hemorrhage control: a narrative review. Mil Med Res 2020; 7: 13
• 24 Deutsche Gesellschaft für Unfallchirurgie e.V. S3-Leitlinie Polytrauma/Schwerverletzten-Behandlung. AWMF Registernummer 187–023, Version 4.0, 31.12.2022. Accessed December 03, 2023 at: https://register.awmf.org/assets/guidelines/187–023l_S3_Polytrauma-Schwerverletzten-Behandlung_2023–02.pdf
• 25 Boulton AJ, Lewis CT, Naumann DN. et al. Prehospital haemostatic dressings for trauma: a systematic review. Emerg Med J 2018; 35: 449-457
• 26 Rossaint R, Afshari A, Bouillon B. et al. The European guideline on management of major bleeding and coagulopathy following trauma: sixth edition. Crit Care 2023; 27: 80
• 27 Helm M, Hossfeld B, Braun B. et al. Oligoanalgesia in Patients with an initial Glasgow Coma Scale Score ≥8 in a Physician-Staffed Helicopter Emergency Medical Service. Anesth Analg 2020; 130: 176-186