Puchwein Paul, Sommerauer Florian, Clement Hans G, Matzi Veronika, Tesch Norbert P, Hallmann Barbara, Harris Tim, Rigaud Marcel
Medical University of Graz, Department for Traumatology, Auenbruggerplatz 5, 8036 Graz, Austria.
Medical University of Graz, Department for Traumatology, Auenbruggerplatz 5, 8036 Graz, Austria.
Injury. 2015 Sep;46(9):1738-42. doi: 10.1016/j.injury.2015.05.045. Epub 2015 May 29.
Selected patients in traumatic cardiac arrest may benefit from pre-hospital thoracotomy. Pre-hospital care physicians rarely have surgical training and the procedure is rarely performed in most European systems. Limited data exists to inform teaching and training for this procedure. We set out to run a pilot study to determine the time required to perform a thoracotomy and the a priori defined complication rate.
We adapted an existing system operating procedure requiring four instruments (Plaster-of-Paris shears, dressing scissors, non-toothed forceps, scalpel) for this study. We identified a convenience sample of surgically trained and non-surgically trained participants. All received a training package including a lecture, practical demonstration and cadaver experience. Time to perform the procedure, anatomical accuracy and a priori complication rates were assessed.
The mean total time for the clamshell thoracotomy from thoracic incision to delivery of the heart was 167 s (02:47 min:sec). There was no statistical difference in the time to complete the procedure or complication rate among surgeons, non-surgeons and students. The complication rate dropped from 36% in the first attempt to 7% in the second attempt but this was not statistically significant. This is a pilot study and small numbers of participants arguably saw it underpowered to define differences between study groups.
Clamshell thoracotomy can be taught using cadaver models. In this simulated environment, the procedure may be performed rapidly with minimum equipment.
部分创伤性心脏骤停患者可能从院前开胸手术中获益。院前急救医生很少接受外科培训，且在大多数欧洲体系中该手术很少实施。用于指导该手术教学和培训的数据有限。我们开展了一项试点研究，以确定实施开胸手术所需的时间以及预先定义的并发症发生率。
我们为此研究采用了一种现有的系统操作流程，该流程需要四种器械（熟石膏剪、敷料剪、无齿镊、手术刀）。我们确定了一个便利样本，包括接受过外科培训和未接受过外科培训的参与者。所有人都接受了一个培训包，包括讲座、实践演示和尸体操作经验。评估了手术执行时间、解剖准确性和预先定义的并发症发生率。
从胸部切口到心脏取出的蛤壳式开胸手术的平均总时间为167秒（02:47分:秒）。外科医生、非外科医生和学生在完成手术的时间或并发症发生率方面没有统计学差异。并发症发生率从首次尝试时的36%降至第二次尝试时的7%，但这在统计学上并不显著。这是一项试点研究，且参与者数量较少，可以说不足以确定研究组之间的差异。
蛤壳式开胸手术可以使用尸体模型进行教学。在这种模拟环境中，该手术可以用最少的设备快速完成。
