Department of Surgery, University of California, San Francisco-East Bay, CA, USA.
J Trauma Acute Care Surg. 2012 Jul;73(1):102-10. doi: 10.1097/TA.0b013e3182569ebc.
The clinical utility of determining cardiac motion on ultrasound has been reported for patients presenting in pulseless medical cardiac arrest. However, the relationship between ultrasound-documented cardiac activity and the probability of surviving pulseless electrical activity has not been examined in populations with trauma. We hypothesized that cardiac activity on ultrasound predicts survival for patients presenting in pulseless traumatic arrest.
We conducted a retrospective analysis at our university-based urban trauma center of adult patients with trauma, who were pulseless on hospital arrival. Results of cardiac ultrasound performed during trauma resuscitations were compared with the electrocardiogram (EKG) rhythm and survival.
Among 318 pulseless patients with trauma, 162 had both EKG tracings and a cardiac ultrasound, and 4.3% of these 162 patients survived to hospital admission. Survival was higher for those with cardiac motion than for those without it (23.5% vs. 1.9% for patients with EKG electrical activity, p = 0.002, and 66.7% vs. 0% for patients without EKG electrical activity, p < 0.001). The sensitivity of ultrasound cardiac motion to predict survival to hospital admission was 86% (specificity, 91%; positive predictive value, 30%; negative predictive value, 99%). When examined by mechanism, sensitivity was 100% for the 111 patients with penetrating trauma and 75% for the 50 patients with blunt trauma.
Survival in pulseless traumatic arrest is very low, but survival for patients with no cardiac motion on ultrasound is also exceedingly rare. Cardiac ultrasound had a negative predictive value approaching 100% for survival to hospital admission. For patients with prolonged prehospital cardiopulmonary resuscitation, ultrasound evaluation of cardiac motion in pulseless patients with trauma may be a rapid way to help determine which patients have no chance of survival in the setting of lethal injuries, so that futile resuscitations can be stopped.
已经有研究报道，在出现无脉性医学心搏骤停的患者中，超声心动图确定心脏运动的临床实用性。然而，在创伤人群中，尚未检查超声心动图记录的心脏活动与无脉性电活动存活概率之间的关系。我们假设超声心动图上的心脏活动可预测出现无脉性创伤性心搏骤停患者的存活。
我们对我们大学附属城市创伤中心的成年创伤患者进行了回顾性分析，这些患者在入院时无脉搏。比较心脏超声检查结果与心电图（EKG）节律和存活情况。
在 318 例创伤性无脉搏患者中，有 162 例同时进行了 EKG 描记和心脏超声检查，其中 4.3%的患者存活至入院。有心脏运动的患者比没有心脏运动的患者存活（EKG 有电活动的患者中为 23.5%比 1.9%，p = 0.002，EKG 没有电活动的患者中为 66.7%比 0%，p < 0.001）。超声心动图心脏运动预测入院存活的敏感性为 86%（特异性为 91%；阳性预测值为 30%；阴性预测值为 99%）。通过机制检查，111 例穿透性创伤患者的敏感性为 100%，50 例钝性创伤患者的敏感性为 75%。
无脉性创伤性心搏骤停患者的存活率非常低，但超声心动图未见心脏运动的患者也极少见存活。超声心动图对入院存活的阴性预测值接近 100%。对于院前心肺复苏时间延长的患者，在出现无脉性创伤的患者中，超声心动图评估心脏运动可能是一种快速确定哪些患者在致命性损伤下没有存活机会的方法，以便停止无益的复苏。
