Stockinger Zsolt T, McSwain Norman E
Department of Surgery SL-22, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA.
J Am Coll Surg. 2004 Feb;198(2):227-31. doi: 10.1016/j.jamcollsurg.2003.10.012.
Survival for trauma patients who receive prehospital cardiopulmonary resuscitation (CPR) has been reported as poor. We assessed the survival for prehospital CPR in our trauma system and attempted to find prehospital predictors of mortality.
We conducted a retrospective review of our Level I trauma center's database that identified 588 patients over a 6-year period (January 1, 1997, to December 31, 2002) who received prehospital CPR. Mechanisms of injury, prehospital vital signs, and survival to discharge were analyzed.
Twenty-two of 588 patients (3.7%) survived to hospital discharge. Overall, 60.7% did not survive to achieve hospital admission, and an additional 32.6% died on the first hospital day. Patients with penetrating injuries had a significantly lower survival rate than those with either blunt or other (eg, drowning, hanging) injuries (0.9% versus 6.2%, and 13.2%, respectively, p < 0.001) and significantly lower Revised Trauma Scores (RTS; mean +/- SD: 0.32 +/- 0.96 versus 0.76 +/- 1.84 and 1.18 +/- 2.51, respectively, p < 0.05.) The likelihood of survival with RTS = 0 was less than 1% overall, and 0% for penetrating trauma.
These findings add support to recent guidelines regarding the termination or withholding of resuscitation for trauma patients in the prehospital setting. Victims of penetrating trauma with a prehospital RTS = 0 (combination of no respiratory rate, no systolic blood pressure, and a Glasgow Coma Score of 3) should be declared "dead at the scene."
据报道，接受院前心肺复苏（CPR）的创伤患者生存率较低。我们评估了我们创伤系统中院前心肺复苏的生存率，并试图找出死亡率的院前预测因素。
我们对一级创伤中心的数据库进行了回顾性研究，该数据库确定了1997年1月1日至2002年12月31日这6年期间接受院前心肺复苏的588例患者。分析了损伤机制、院前生命体征和出院生存率。
588例患者中有22例（3.7%）存活至出院。总体而言，60.7%的患者未能存活至入院，另有32.6%的患者在入院第一天死亡。穿透伤患者的生存率显著低于钝性伤或其他（如溺水、上吊）伤患者（分别为0.9%、6.2%和13.2%，p<0.001），且修订创伤评分（RTS；均值±标准差：分别为0.32±0.96、0.76±1.84和1.18±2.51，p<0.05）显著较低。RTS = 0时的总体存活可能性小于1%，穿透伤患者为0%。
这些发现为近期关于院前环境中创伤患者复苏终止或放弃的指南提供了支持。院前RTS = 0（无呼吸频率、无收缩压且格拉斯哥昏迷评分为3的组合）的穿透伤受害者应被宣布为“现场死亡”。
