Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
Resuscitation. 2014 Mar;85(3):405-10. doi: 10.1016/j.resuscitation.2013.11.009. Epub 2013 Nov 25.
Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA.
Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n=101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n=52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n=22) and trauma-management failures were prospectively assessed.
In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death.
Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.
尽管创伤救治领域不断创新，但致命性创伤仍然是一个重大的医学和社会经济学问题。创伤性心脏骤停（tCA）仍然被认为是一种无望的情况，而管理失误和死亡的可预防性被忽视。我们分析了基于急诊医师的救援系统中 tCA 患者的临床和尸检数据，以揭示 tCA 成功治疗中的流行病学数据和当前问题。
在德国柏林的一年期间，对所有不成功的 tCPR 病例（n=101，I 组）的流行病学和尸检数据以及在 6 年期间在一级创伤中心的所有 tCPR 病例的临床数据（n=52，II 组）进行了评估。前瞻性评估了尸检病例（n=22）的创伤性死亡的可预防性和创伤管理失败。
2010 年，柏林所有创伤性死亡中有 23%接受了 tCPR。tCPR 后死亡主要发生在院前（PH；74%），只有 26%的这些患者住院。在 52 例患者中（II 组），46%在 PH 时需要 tCPR，81%在急诊部（ED）。PH 时 79%建立了 ROSC，ED 时 53%。tCPR 后的存活率为 29%，其中 27%有良好的神经功能结局。管理失误发生在 PH 时的 73%；4 例被判断为潜在或明确可预防的死亡。
创伤性 CPR 已经超出了常规，需要制定 tCPR 算法，包括胸部/心包减压、外部骨盆稳定和外部出血控制。院前创伤管理具有提高 tCPR 和生存率的最大潜力。因此，我们建议了一个院前 tCPR 算法的试点。
