Training non-surgeons to perform resuscitative thoracotomy

König, Thomas; Perkins, Zane; Davies, GE

doi:10.1186/1757-7241-21-s1-a2

Cited by 7 publications

(6 citation statements)

References 8 publications

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“…ä.) [20,30] zu leisten. Eine Tätigkeit in einer operativen Fachrichtung scheint für die Entlastung der Perikardtamponade oder die proximale Aortenkompression nicht erforderlich.…”

Section: Indikationenunclassified

“…Vor dem Hintergrund, dass Thoraxkompressionen bei der Perikardtamponade oder dem Spannungspneumothorax (nahezu) nicht wirksam sind, ist es nicht möglich, durch die Herzdruckmassage auf dem Transport die Perfusion vulnerabler Organe zu erhalten. Die Zeit bis in den OP bedeutet somit No-Flow [2,20]. Hinzu kommt, dass eine direkte Übergabe vom Rettungsdienst in den OP in den meisten Kliniken unüblich ist, sodass es hier naturgemäß zu weiteren Zeitverlusten und organisatorischen Schwierigkeiten kommt.…”

Section: Durchführung Im Opunclassified

“…Wenngleich es verschiedene Techniken der (Notfall)Thorakotomie gibt, so setzte sich in den letzten Jahren die als Clamshell-Thorakotomie bezeichnete Technik durch. Die Prozedur ist schnell, einfach zu erlernen [19,20] [20]. Andere Luftrettungsdienste wie z.…”

Section: Technikunclassified

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Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

Rudolph

Lange

Göring

et al. 2019

Notarzt

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ZusammenfassungDie Notfallthorakotomie beim traumatischen Herz-Kreislauf-Stillstand spielte in Deutschland lange Zeit eine untergeordnete Rolle. Nach der Veröffentlichung der Reanimationsleitlinien des ERCs 2015 rückte der Algorithmus zur Versorgung dieses Verletzungsmusters in den Mittelpunkt, und speziell die Notfallthorakotomie war Auslöser einiger kontroverser Diskussionen. Die vorliegende Arbeit beschreibt nun die Indikationen für eine Thorakotomie im Rahmen einer Reanimation und erläutert die nötigen Rahmenbedingungen. Weiterhin wird die Technik Schritt für Schritt beschrieben. Darüber hinaus erfolgt eine kritische Betrachtung der Implementierung der Technik in unser Rettungsdienstsystem sowie der Hinweis auf bestehende Schulungskonzepte.

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“…ä.) [20,30] zu leisten. Eine Tätigkeit in einer operativen Fachrichtung scheint für die Entlastung der Perikardtamponade oder die proximale Aortenkompression nicht erforderlich.…”

Section: Indikationenunclassified

Section: Durchführung Im Opunclassified

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Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

Rudolph

Lange

Göring

et al. 2019

Notarzt

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“…5, No. 2, 2021 use has been described in the treatment of traumatic cardiac arrest by non-surgeons in the pre-hospital phase of care [7,8]. It is effective for penetrating injuries with cardiac tamponade or a thoracic source of haemorrhage [9].…”

Section: Introductionmentioning

confidence: 99%

A Practical Approach to Introducing Pre-Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), the Problems Encountered and Lessons Learned

Chana

Perkins²,

Lendrum

et al. 2021

JEVTM

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Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) is an endovascular procedure which utilises a catheter based balloon device to achieve aortic occlusion. The aim of this resuscitative measure is to improve blood pressure proximal to the occlusion site and therefore preserve cardiac and cerebral perfusion in order to prevent cardiac arrest; additionally there is a relative reduction in arterial inflow to the site of injury. Endovascular techniques are gaining acceptance for the in-hospital management of haemorrhage, however their use in pre-hospital care is still limited. This is due to a number of factors including the technical challenges, training and skill sets of pre-hospital care teams and the potential for harm of REBOA, particularly with extended balloon occlusion times. However, non compressible torso haemorrhage is associated with a mortality of approximately 50% and a significant proportion of these deaths occur in the pre-hospital phase of care. In the exsanguinating patient, resuscitative thoracotomy (RT) with direct aortic compression is often the only means to control haemorrhage. This resuscitative measure is now an established pre-hospital intervention which has significantly improved outcomes in the context of penetrating trauma, particularly thoracic injury. In the context of blunt injury and subdiaphragmatic haemorrhage, however, the outcomes from pre-hospital resuscitative thoracotomy remain poor. We present our initial technique for successfully introducing REBOA for the pre-hospital management of exsanguinating pelvic or groin heamorrhage following trauma, our indications for REBOA and comment on the problems and limitations encountered as well the lessons learned.

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“…The curriculum of the Australasian College for Emergency Medicine suggests that Fellows should be able to perform the life‐ and sight‐saving procedures of resuscitative thoracotomy, cricothyroidotomy and lateral canthotomy, but because of their clinical rarity, procedural competence is difficult to acquire . Focused workshops exist for resuscitative thoracotomy, and training in lateral canthotomy is also described in the literature, but more limited opportunities exist to train for a wider range of surgical procedures in a single workshop. The authors are aware of one such workshop in the United Kingdom, but none in Australasia targeted to non‐surgeons .…”

Section: Introductionmentioning

confidence: 99%

A human cadaveric workshop: One solution to competence in the face of rarity

Ferguson

Shareef

Burns

et al. 2016

Emerg Medicine Australasia

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Competent performance of cricothyroidotomy, lateral canthotomy and resuscitative thoracostomy is an expected standard for Australasian emergency physicians, but infrequent exposure to these procedures could impair physician confidence, reducing the likelihood of their execution in a critical timeframe. Training to perform these procedures is a recognised challenge for non-surgeons, and cadaver-based training is one method of addressing this need. We describe a 1 day cadaver-based workshop for emergency medicine doctors and briefly report on its impact on physician confidence. This workshop appeared effective in increasing the confidence of emergency medicine physicians to carry out rarely performed life and sight-saving procedures and also provides an opportunity for senior clinicians to increase compliance with continuing profession development schemes.

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Training non-surgeons to perform resuscitative thoracotomy

Cited by 7 publications

References 8 publications

Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

Clamshell-Thorakotomie im Rettungsdienst und Schockraum: Indikationen, Anforderungen und Technik

A Practical Approach to Introducing Pre-Hospital Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA), the Problems Encountered and Lessons Learned

A human cadaveric workshop: One solution to competence in the face of rarity

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