Trauma cranio-encefalico

Per professionisti sanitari. Le informazioni non sostituiscono la valutazione clinica del singolo caso; fanno fede il riassunto delle caratteristiche del prodotto aggiornato e le linee guida citate.

Revisione medica: Dr. med. univ. Daniel Pehböck, DESA, 03.11.2026

Trauma cranio-encefalico: Classificazione secondo la GCS, Obiettivi preospedalieri – prevenire il danno cerebrale secondario, Vie aeree, ventilazione, anestesia, Erniazione imminente – riconoscere e fare da ponte, Acido tranexamico, Anticoagulanti e antiaggreganti piastrinici – in sintesi per i team di emergenza, anestesia e terapia intensiva, con fonti e revisione medica.

Contenuto del capitolo

1. Classificazione secondo la GCS
2. Obiettivi preospedalieri – prevenire il danno cerebrale secondario
3. Vie aeree, ventilazione, anestesia
4. Erniazione imminente – riconoscere e fare da ponte
5. Acido tranexamico
6. Anticoagulanti e antiaggreganti piastrinici
7. Crisi convulsiva
8. Ospedale di destinazione e passaggio di consegne
9. TCE lieve – chi ha bisogno di una TC?
10. Bambini
11. Pazienti anziani e anticoagulati

Farmaci in questo capitolo

• Acido tranexamico
• Concentrato di complesso protrombinico (CCP)
• Fitomenadione
• Idarucizumab
• Andexanet alfa

Fonti e linee guida

1. Firsching R, Rickels E, Mauer UM, Sakowitz OW, Messing-Jünger M, Engelhard K et al. (DGNC, DGAI, DGN, DGNR, DGU u. a.). S2e-Leitlinie Schädel-Hirn-Trauma im Erwachsenenalter, AWMF-Register-Nr. 008-001, Update 2015 (Lang- und Kurzfassung 12/2015 bzw. 06/2016)
2. GNPI, DGNC, DGKCH u. a. S2k-Leitlinie Das Schädel-Hirn-Trauma im Kindes- und Jugendalter, AWMF-Register-Nr. 024-018, Endfassung 14.02.2022 (Registerdokument 03/2023)
3. Lulla A, Lumba-Brown A, Totten AM et al. Prehospital Guidelines for the Management of Traumatic Brain Injury.
4. Brain Trauma Foundation. Guidelines for Prehospital Management of Traumatic Brain Injury, 3rd Edition (Lulla A et al.). Prehosp Emerg Care 2023;27(5):507–538; Executive Summary: Hawryluk GWJ et al. Neurosurgery 2023;93(6):E159–E169.
5. Badjatia N, Carney N, Crocco TJ et al. Guidelines for Prehospital Management of Traumatic Brain Injury, 2nd Edition. Prehosp Emerg Care 2008;12 Suppl 1:S1–S52 (Brain Trauma Foundation): Hypoxämie < 90 % und Hypotonie < 90 mmHg systolisch vermeiden; Normoventilation (etCO₂ 35–40 mmHg); Herniationszeichen.
6. Carney N, Totten AM, O'Reilly C et al. Guidelines for the Management of Severe Traumatic Brain Injury, Fourth Edition. Neurosurgery 2017;80:6–15 (Brain Trauma Foundation, online 09/2016)
7. Kochanek PM, Tasker RC, Carney N et al. Guidelines for the Management of Pediatric Severe Traumatic Brain Injury, Third Edition: Update of the Brain Trauma Foundation Guidelines. Pediatr Crit Care Med 2019;20(3S Suppl 1):S1–S82: Bolus hypertoner Kochsalzlösung 3 % bei intrakranieller Hypertension, wirksame Akutdosis 2–5 ml/kg über 10–20 min (Level II); Dauerinfusion 0,1–1,0 ml/kg/h; 23,4 % 0,5 ml/kg (max. 30 ml) bei refraktärem Hirndruck.
8. Rossaint R, Afshari A, Bouillon B et al. The European guideline on management of major bleeding and coagulopathy following trauma.
9. Ruhigstellung der Halswirbelsäule in der Präklinik. Notfall Rettungsmed 2023 (Übersicht auf Basis der S3-Leitlinie 187-023: Immobilisation beim Polytrauma indiziert; Zervikalstütze bei SHT kritisch.
10. National Institute for Health and Care Excellence (NICE). Head injury.
11. Stiell IG, Wells GA, Vandemheen K et al. The Canadian CT Head Rule for patients with minor head injury. Lancet 2001;357:1391–1396.
12. Kuppermann N, Holmes JF, Dayan PS et al. (PECARN). Identification of children at very low risk of clinically-important brain injuries after head trauma.
13. CRASH-3 trial collaborators. Effects of tranexamic acid on death, disability, vascular occlusive events and other morbidities in patients with acute traumatic brain injury (CRASH-3)
14. Neurocritical Care Society. Emergency Neurological Life Support (ENLS)
15. Neurocritical Care Society. ENLS Version 4.0.
16. Bulger EM, May S, Wasserberger J et al. (ROC). Out-of-hospital hypertonic resuscitation following severe traumatic brain injury.
17. apotheke adhoc: Hydroxyethylstärke-Lösungen gehen außer Handel.
18. Edwards P, Arango M, Balica L et al. (CRASH trial collaborators). Final results of MRC CRASH, a randomised placebo-controlled trial of intravenous corticosteroid in adults with head injury.
19. European Society of Anaesthesiology and Intensive Care (ESAIC). Clinical guideline on reversal of direct oral anticoagulants in patients with life threatening bleeding. Eur J Anaesthesiol 2024;41(5):327–350.
20. Christensen H, Cordonnier C, Kõrv J et al. European Stroke Organisation Guideline on Reversal of Oral Anticoagulants in Acute Intracerebral Haemorrhage. Eur Stroke J 2019;4(4):294–306.
21. Neurocritical Care Society (NCS) und Society of Critical Care Medicine (SCCM). Treatment of Antithrombotic-Associated Intracranial Hemorrhage in Adults: A Focused Guideline Update. Neurocrit Care 2026, online 24.09.2026 (aktualisiert die NCS/SCCM-Leitlinie 2016)
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24. Djakow J, Turner NM, Skellett S et al. European Resuscitation Council Guidelines 2025 Paediatric Life Support. Resuscitation 2025;215 Suppl 1:110767.
25. AWMF-Leitlinienregister, Registernummer 008-001 Schädel-Hirn-Trauma im Erwachsenenalter: Neufassung als S2e-Leitlinie (Version 3.0) angemeldet am 31.10.2025, geplante Fertigstellung 31.12.2026, federführend Deutsche Gesellschaft für Neurochirurgie (DGNC)
26. Neurocritical Care Society. Emergency Neurological Life Support (ENLS) Version 5.0.
27. Riassunti delle caratteristiche dei prodotti autorizzati – prodotto e sezione per ogni dose nell'app.