Medizinische Aspekte bei Lawinenunfällen – ein Update

Zusammenfassung

Lawinenunfälle haben eine durchschnittliche Mortalität von 25 %. Vier Faktoren sind ausschlaggebend für das Überleben der Opfer: Ausmaß und Dauer der Verschüttung, ein offener Atemweg und die Schwere der erlittenen Verletzungen. Dieser Artikel liefert eine Übersicht über pathophysiologische Aspekte der Lawinenverschüttung sowie die aktuellen Empfehlungen für die präklinische und innerklinische Behandlung von Lawinenopfern. Das European Resuscitation Council ERC hat klare und bindende Empfehlungen für die medizinische Versorgung herausgegeben. ECLS (Extracorporeal Life Support), das heißt die Behandlung von Lawinenopfern mittels aktiv-invasiven Aufwärmmethoden, ist indiziert, wenn die Verschüttungsdauer mehr als 60 Minuten, die Kerntemperatur < 30°, das Kalium < 8mmol/l ist und ein offener Atemweg vorhanden war. Zusätzlich haben die Schwere der Verletzungen und eine gut funktionierende Rettungskette einen gewichtigen Einfluss auf das Überleben der Opfer. Eine Lawinencheckliste wurde entwickelt, um die Entscheidungsfindung prähospital zu vereinfachen und die Übergabe an die klinisch tätigen Teams zu optimieren.

Abstract

Avalanche accidents have an average mortality rate of 25 %. Four factors determine the survival chances: the degree and length of avalanche burial, the patency of the airway and the severity of traumatic injuries. Aim of this update is to provide an overview of new pathophysiological aspects of avalanche burial and of the current recommendations for the treatment of avalanche victims, including pre- and in-hospital management. The European Resuscitation Council has released specific recommendations to provide guidance to health care providers. The cut-off criteria for prolonged cardiopulmonary resuscitation and extracorporeal rewarming of avalanche victims in cardiac arrest are more stringent. Extracorporeal cardiac life support may be indicated if duration of burial is > 60 minutes or core temperature < 30°, airway is patent and serum potassium ≤ 8 mmol/l. Trauma severity and a well-functioning rescue chain have additional major impact on the outcome of these patients. An avalanche victim resuscitation checklist has been created in an attempt to improve the quality of pre-hospital patient care and the handover to the in-hospital medical team.

Key words

avalanche - survival, European Resuscitation Council - avalanche checklist - extracorporeal life support

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