Critical Care and Emergency Center, Yokohama City University, Medical Center 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan.
World J Surg. 2011 Jan;35(1):34-42. doi: 10.1007/s00268-010-0798-4.
There are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system.
The 477 BT-CPA registry data were augmented by a review of the detailed medical records in our emergency department (ED) and action reports in the prehospital EMS records.
Of those, 76% were witnessed and 20% were CPA after leaving the scene. In all, 18% of the patients went to the intensive care unit (ICU), the transcatheter arterial embolization (TAE) room, or the operating room (OR). Only 3% survived to be discharged. Among the 363 witnessed patients-11 of whom had ventricular fibrillation (VF) as the initial rhythm, 134 exhibiting pulseless electrical activity (PEA), and 221 with asystole-13, 1, and 3%, respectively, survived to discharge. The most common initial rhythm just after collapse was not VF but PEA, and asystole increased over the 7 min after collapse. There were no differences in the interval between arrival at the hospital and the return of spontaneous circulation between the patients that survived to discharge and deceased patients in the ED, OR, TAE room, or ICU. The longest interval was 17 min.
In BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.
钝性创伤性心搏骤停（BT-CPA）患者的治疗策略较少。本基于人群的病例系列观察性研究旨在阐明在具有快速转运系统的紧急医疗服务（EMS）系统下进行急诊科开胸术（EDT）的标准化治疗策略治疗 BT-CPA 患者的结局。
对 477 例 BT-CPA 登记数据进行了扩充，包括对我院急诊科详细病历的审查和院前 EMS 记录中的行动报告。
其中，76%有目击者，20%离开现场后发生 CPA。总共 18%的患者进入重症监护病房（ICU）、经导管动脉栓塞（TAE）室或手术室（OR）。仅有 3%存活出院。在 363 例有目击者的患者中，有 11 例初始节律为心室颤动（VF），134 例为无脉性电活动（PEA），221 例为心搏停止，分别有 13%、1%和 3%存活出院。刚发生心搏骤停时最常见的初始节律不是 VF，而是 PEA，心搏停止在发生心搏骤停后 7 分钟内逐渐增加。在急诊科、OR、TAE 室或 ICU 中，存活出院患者和死亡患者到达医院和自主循环恢复之间的间隔没有差异。最长间隔为 17 分钟。
在 BT-CPA 患者中，可能需要进行 20 分钟的复苏努力并终止复苏。初始节律不是预后指标。我们认为，应根据具体情况决定是否进行积极的复苏努力。
