Mollberg Nathan M, Wise Stephen R, Berman Kevin, Chowdhry Saeed, Holevar Michelle, Sullivan Ryan, Vafa Amir
Division of General Surgery, Department of Surgery, University of Illinois at Mount Sinai Hospital, Chicago, Illinois 60608, USA.
J Trauma. 2011 Oct;71(4):997-1002. doi: 10.1097/TA.0b013e3182318269.
The validity of current guidelines regarding resuscitation of patients in traumatic cardiopulmonary arrest (TCPA) and the ability of emergency medical services (EMS) to appropriately apply them have been called into question. The purpose of this study is to demonstrate the consequences of violating the current published guidelines and whether EMS personnel were able to accurately identify patients in TCPA.
We conducted a retrospective review of our Level I trauma center's database that identified 294 patients over an 8-year period (January 1, 2003, to December 31, 2010) who suffered prehospital TCPA and met criteria for the withholding or termination of resuscitation based on current guidelines. Patient demographics, prehospital/emergency department physiology, survival, neurologic outcome, and hospital charges were analyzed.
One of 294 patients (0.3%) survived to reach hospital discharge with a Glasgow Coma Scale score of 6. The total costs incurred for these 294 patients meeting criteria for withholding or termination of resuscitation were $3,852,446.65. One hundred seventeen (39.8%) patients were evaluated by more than one EMS team. There was 100% agreement on the presence (15 of 15) or absence (102 of 102) of a pulse between the EMS teams.
Our data support the current guidelines regarding the withholding or termination of resuscitation of patients in prehospital TCPA and represent the largest series to date on this topic. EMS personnel were able to accurately determine traumatic cardiac arrest in the field in this series. Violation of the current guidelines resulted in six patients being resuscitated to a neurologically devastated state. No loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained.
当前关于创伤性心肺骤停（TCPA）患者复苏的指南的有效性以及紧急医疗服务（EMS）人员适当应用这些指南的能力受到了质疑。本研究的目的是证明违反当前已发表指南的后果，以及EMS人员是否能够准确识别TCPA患者。
我们对一级创伤中心的数据库进行了回顾性分析，该数据库确定了在8年期间（2003年1月1日至2010年12月31日）发生院外TCPA且符合基于当前指南进行复苏 withhold 或终止标准的294例患者。分析了患者的人口统计学、院前/急诊科生理指标、生存率、神经学转归和医院费用。
294例患者中有1例（0.3%）存活至出院，格拉斯哥昏迷量表评分为6分。这294例符合复苏 withhold 或终止标准的患者产生的总费用为3,852,446.65美元。117例（39.8%）患者由不止一个EMS团队进行评估。EMS团队之间在脉搏存在（15例中的15例）或不存在（102例中的102例）方面的一致性为100%。
我们的数据支持当前关于院外TCPA患者复苏 withhold 或终止的指南，并且是迄今为止关于该主题的最大系列研究。在本系列中，EMS人员能够在现场准确确定创伤性心脏骤停。违反当前指南导致6例患者复苏至神经功能严重受损状态。如果严格遵守指南，不会导致神经功能完好的幸存者丧失。
