Tuma Mazin A, Stansbury Lynn G, Stein Deborah M, McQuillan Karen A, Scalea Thomas M
R Adams Cowley Shock Trauma Center, Baltimore, MD 21201, USA.
J Trauma. 2011 Dec;71(6):1524-7. doi: 10.1097/TA.0b013e31823c5a06.
Induced hypothermia after cardiac arrest is an accepted neuroprotective strategy. However, its role in cardiac arrest during acute trauma care is not yet defined. To characterize recent experience with this technique at our center, we undertook a detailed chart review of acute trauma patients managed with induced hypothermia after cardiac arrest.
From Trauma Registry records, we identified all adult patients (older than 17 years) admitted to our Level I trauma center from July 1, 2008, through June 30, 2010, who experienced cardiac arrest during acute trauma care and were managed via our induced hypothermia protocol. This requires maintenance of core body temperature between 32°C and 34°C for 24 hours after arrest. Patient clinical records were then reviewed for selected factors.
Six acute trauma patients (3 male and 3 female; median age, 53 years) with cardiac arrest managed per protocol were identified. All injuries were due to blunt impact, and five of six injuries were motor-vehicle-associated. Median Injury Severity Score was 27; median prearrest Glasgow Coma Scale (GCS) score was 15. One patient arrested prehospital and the other 5 in-hospital. Median duration of arrest was 8 minutes. All were comatose after arrest. One death occurred, in the patient with a prehospital cardiac arrest. Two patients were discharged to chronic care facilities with GCS11-tracheostomy; three were discharged to active rehabilitation care facilities with GCS score of 14 to 15. There were no obvious complications related to cooling.
Mild induced hypothermia can be beneficial in a selected group of trauma patients after cardiac arrest. Prospective trials are needed to explore the effects of targeted temperature management on coagulation in this patient group.
心脏骤停后诱导性低温是一种公认的神经保护策略。然而，其在急性创伤救治中发生心脏骤停时的作用尚未明确。为了描述我们中心近期使用该技术的经验，我们对心脏骤停后接受诱导性低温治疗的急性创伤患者进行了详细的病历回顾。
从创伤登记记录中，我们确定了2008年7月1日至2010年6月30日期间入住我们一级创伤中心的所有成年患者（年龄大于17岁），这些患者在急性创伤救治期间发生心脏骤停，并按照我们的诱导性低温方案进行治疗。这需要在心脏骤停后24小时内将核心体温维持在32°C至34°C之间。然后对患者的临床记录进行选定因素的审查。
确定了6例按照方案治疗的心脏骤停急性创伤患者（3例男性和3例女性；中位年龄53岁）。所有损伤均由钝器撞击所致，6例损伤中有5例与机动车相关。中位损伤严重程度评分为27分；心脏骤停前格拉斯哥昏迷量表（GCS）中位评分为15分。1例患者在院前发生心脏骤停，另外5例在院内发生。中位心脏骤停持续时间为8分钟。所有患者在心脏骤停后均昏迷。1例院前心脏骤停患者死亡。2例患者以GCS评分为11分且行气管切开术的状态出院至长期护理机构；3例患者以GCS评分为14至15分的状态出院至积极康复护理机构。未发现与降温相关的明显并发症。
轻度诱导性低温对特定组别的心脏骤停后创伤患者可能有益。需要进行前瞻性试验来探讨目标温度管理对该患者群体凝血功能的影响。
