Narvestad J K, Meskinfamfard M, Søreide K
Department of Gastrointestinal Surgery, Stavanger University Hospital, POB 8100, 4068, Stavanger, Norway.
Department of Clinical Medicine, University of Bergen, Bergen, Norway.
Eur J Trauma Emerg Surg. 2016 Dec;42(6):677-685. doi: 10.1007/s00068-015-0559-z. Epub 2015 Aug 18.
Emergency resuscitative thoracotomy (ERT) is a lifesaving procedure in selected patients. Indications are still being debated, but outcome in blunt trauma is believed to be poor. Recent reports from European populations, where blunt trauma predominates, have suggested favorable outcome also in blunt trauma. Our aim was to identify all European studies reported over the last decade and compare reported outcomes to existing knowledge.
We performed a systematic literature search according to PRISMA guidelines (January 1st, 2004 to December 31st, 2014). The "grey literature" was included by searching Google Scholar. Qualitative comparison of studies and outcomes was done.
A total of 8 articles from Europe were included originating from Croatia, Norway (n = 2), Denmark, Iceland, the Netherlands, Scotland, and Switzerland. Of 376 resuscitative thoracotomies, 193 (51.3 %) were for blunt trauma. Male:female distribution was 3.5:1. The collectively reported overall survival was 42.8 % (n = 161), with 25.4 % (49 of 193) blunt trauma and 61.2 % (112 of 183) penetrating injuries. When strictly including those ERTs designated as done in the emergency department for blunt mechanism (n = 139) only, a total of 18 patients survived (12.9 %). Survival after EDTs for penetrating trauma was 41.6 % (37 of 89). Neurological outcome (reported in 5 of 8 studies) reported favorable neurological long-term outcome in the majority of survivors, even after blunt trauma. None referred to Glasgow Outcome Score. Heterogeneity in the studies prevented outcome analyses by formal quantitative meta-analysis.
The reported outcome after ERT in European civilian trauma populations is favorable, with one in every four ERTs in the ED surviving. Notably, outcome is at variance with previously reported collective data, in particular for blunt trauma. Multicenter, prospective, observational data are needed to validate the modern role of ERT in blunt trauma.
急诊复苏性开胸手术（ERT）对特定患者而言是一种挽救生命的手术。其适应症仍存在争议，但一般认为钝性创伤患者接受该手术后预后较差。欧洲人群中钝性创伤较为常见，近期的报告显示钝性创伤患者接受ERT后也可能有良好预后。我们的目的是找出过去十年间欧洲报道的所有相关研究，并将报告的结果与现有认知进行比较。
我们按照PRISMA指南（2004年1月1日至2014年12月31日）进行了系统的文献检索。通过搜索谷歌学术纳入了“灰色文献”。对研究和结果进行了定性比较。
共纳入来自欧洲的8篇文章，分别来自克罗地亚、挪威（2篇）、丹麦、冰岛、荷兰、苏格兰和瑞士。在376例复苏性开胸手术中，193例（51.3%）是因钝性创伤。男女比例为3.5:1。总体报告的总生存率为42.8%（n = 161），其中钝性创伤患者生存率为25.4%（193例中的49例），穿透伤患者生存率为61.2%（183例中的112例）。若严格仅纳入那些在急诊科针对钝性机制进行的ERT（n = 139），则共有18例患者存活（12.9%）。穿透伤患者接受急诊开胸手术后的生存率为41.6%（89例中的37例）。神经学结果（8项研究中的5项有报告）显示，即使是钝性创伤患者，大多数幸存者的神经学长期预后良好。均未提及格拉斯哥预后评分。研究的异质性使得无法通过正式的定量荟萃分析进行结果分析。
欧洲平民创伤人群接受ERT后的报告结果良好，急诊科每4例ERT患者中有1例存活。值得注意的是，该结果与之前报告的总体数据不同，尤其是钝性创伤患者。需要多中心、前瞻性、观察性数据来验证ERT在钝性创伤中的现代作用。
