Carlucci Marcelo T O, Braz José R C, do Nascimento Paulo, de Carvalho Lidia R, Castiglia Yara M M, Braz Leandro G
Department of Anesthesiology, Botucatu Medical School, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
Department of Biostatistics, Institute of Biosciences, UNESP - Univ Estadual Paulista, Botucatu, São Paulo, Brazil.
PLoS One. 2014 Feb 27;9(2):e90125. doi: 10.1371/journal.pone.0090125. eCollection 2014.
Little information on the factors influencing intraoperative cardiac arrest and its outcomes in trauma patients is available. This survey evaluated the associated factors and outcomes of intraoperative cardiac arrest in trauma patients in a Brazilian teaching hospital between 1996 and 2009.
Cardiac arrest during anesthesia in trauma patients was identified from an anesthesia database. The data collected included patient demographics, ASA physical status classification, anesthesia provider information, type of surgery, surgical areas and outcome. All intraoperative cardiac arrests and deaths in trauma patients were reviewed and grouped by associated factors and also analyzed as totally anesthesia-related, partially anesthesia-related, totally surgery-related or totally trauma patient condition-related.
Fifty-one cardiac arrests and 42 deaths occurred during anesthesia in trauma patients. They were associated with male patients (P<0.001) and young adults (18-35 years) (P=0.04) with ASA physical status IV or V (P<0.001) undergoing gastroenterological or multiclinical surgeries (P<0.001). Motor vehicle crashes and violence were the main causes of trauma (P<0.001). Uncontrolled hemorrhage or head injury were the most significant associated factors of intraoperative cardiac arrest and mortality (P<0.001). All cardiac arrests and deaths reported were totally related to trauma patient condition.
Intraoperative cardiac arrest and mortality incidence was highest in male trauma patients at a younger age with poor clinical condition, mainly related to uncontrolled hemorrhage and head injury, resulted from motor vehicle accidents and violence.
关于影响创伤患者术中心脏骤停及其预后的因素，目前可用信息较少。本调查评估了1996年至2009年期间巴西一家教学医院创伤患者术中心脏骤停的相关因素及预后。
从麻醉数据库中识别创伤患者麻醉期间的心脏骤停情况。收集的数据包括患者人口统计学信息、美国麻醉医师协会（ASA）身体状况分类、麻醉提供者信息、手术类型、手术部位及预后。对所有创伤患者术中心脏骤停及死亡情况进行回顾，并按相关因素分组，同时分析其与麻醉完全相关、部分与麻醉相关、完全与手术相关或完全与创伤患者病情相关。
创伤患者麻醉期间发生了51次心脏骤停和42例死亡。这些情况与男性患者（P<0.001）、18 - 35岁的年轻人（P = 0.04）、ASA身体状况为IV或V级（P<0.001）且接受胃肠或多科室手术的患者（P<0.001）有关。机动车碰撞和暴力是创伤的主要原因（P<0.001）。术中心脏骤停和死亡率的最显著相关因素是出血失控或头部受伤（P<0.001）。报告的所有心脏骤停和死亡均完全与创伤患者病情相关。
术中心脏骤停和死亡率在临床状况较差的年轻男性创伤患者中最高，主要与出血失控和头部受伤有关，这些创伤由机动车事故和暴力导致。
