Department of Surgery, Walsgrave Hospital, Coventry CV22 5PX, UK.
Emerg Med J. 2009 Oct;26(10):738-40. doi: 10.1136/emj.2008.065599.
Tension and bilateral pneumothorax can cause or contribute to death following trauma. A surgical incision (thoracostomy) or needle decompression through the chest wall rapidly treats these conditions. Resuscitation of patients in traumatic cardiac arrest focuses on treating common and reversible life-threatening conditions. A study was undertaken to observe the practice, findings and outcome of chest decompression when performed as part of the resuscitation strategy of these patients by air ambulance crews.
Patients in prehospital traumatic cardiac arrest were identified over a 39-month period from an air ambulance database. The use of thoracostomy or needle decompression was identified together with indications, findings and outcome. Primary outcome was return of cardiac output by arrival at hospital.
18 of 37 cases underwent chest decompression (17 thoracostomy, 1 needle decompression). Four patients had a return of cardiac output (3 tension pneumothorax, 1 bilateral pneumothorax). Six further cases were positive for intrathoracic injury. In 2 cases the injuries identified were incompatible with life and resuscitation efforts were consequently ceased.
Chest decompression in traumatic cardiac arrest identifies and treats a high proportion of potentially life-ending injuries and should be considered as part of the resuscitation effort of patients in traumatic cardiac arrest. In a proportion of patients, non-survivable injuries are identified which guide resuscitation efforts.
创伤后张力性气胸和双侧气胸可导致或促成死亡。通过手术切口（开胸术）或经胸壁穿刺减压可迅速治疗这些情况。创伤性心脏骤停患者的复苏重点是治疗常见和可逆转的危及生命的情况。本研究旨在观察空运急救人员在这些患者的复苏策略中进行胸部减压的操作、发现和结果。
在 39 个月的时间里，从空运急救数据库中确定了院前创伤性心脏骤停患者。确定了开胸术或穿刺减压的使用情况，以及其适应证、发现和结果。主要结果是到达医院时心输出量的恢复。
18 例 37 例患者接受了胸部减压（17 例开胸术，1 例穿刺减压）。4 例患者心输出量恢复（3 例张力性气胸，1 例双侧气胸）。另外 6 例进一步发现存在胸腔内损伤。在 2 例病例中，确定的损伤无法存活，因此停止了复苏努力。
创伤性心脏骤停中的胸部减压可识别和治疗很大比例的潜在致死性损伤，应被视为创伤性心脏骤停患者复苏努力的一部分。在一定比例的患者中，确定了不可存活的损伤，这指导了复苏努力。
