Van Vledder Mark G, Van Waes Oscar J F, Kooij Fabian O, Peters Joost H, Van Lieshout Esther M M, Verhofstad Michael H J
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Trauma Research Unit, Department of Surgery, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.
Injury. 2017 Sep;48(9):1865-1869. doi: 10.1016/j.injury.2017.04.002. Epub 2017 Apr 15.
Emergency department thoracotomy is an established procedure for cardiac arrest in patients suffering from penetrating thoracic trauma and yields relatively high survival rates (up to 21%) in patients with cardiac tamponade. To minimize the delay between arrest and thoracotomy, some have advocated thoracotomy on the accident scene. The aim of this study was to determine the proportion of patients with return of spontaneous circulation and subsequent survival after out of hospital thoracotomy in the Netherlands.
A retrospective analysis of data collected on all out of hospital thoracotomies performed in the Netherlands after penetrating trauma between April 1st, 2011 and September 30th, 2016 was performed. Data on patient characteristics, trauma mechanism and outcome were collected and analyzed. Primary outcome measure was return of spontaneous circulation after the intervention. Survival to hospital discharge was the secondary outcome variable.
Thirty-three prehospital emergency thoracotomies were performed. Ten patients (30%) had gunshot wounds and 23 patients (70%) had stab wounds. Nine patients (27%) had return of spontaneous circulation and were presented to the hospital. Of these, one patient survived until discharge without neurological damage. Five died in the emergency department or operating room and three died in ICU.
Return of spontaneous circulation after out of hospital thoracotomy for cardiac arrest due to penetrating thoracic injury is achievable, but a substantial number of patients die during the in hospital resuscitation phase. However, neurologic intact survival can be achieved.
急诊开胸手术是治疗穿透性胸部创伤患者心脏骤停的既定程序，对于心包填塞患者，其生存率相对较高（可达21%）。为了尽量减少心脏骤停与开胸手术之间的延迟，一些人主张在事故现场进行开胸手术。本研究的目的是确定荷兰院外开胸手术后自主循环恢复及后续生存的患者比例。
对2011年4月1日至2016年9月30日在荷兰进行的所有穿透性创伤后院外开胸手术收集的数据进行回顾性分析。收集并分析患者特征、创伤机制和结局的数据。主要结局指标是干预后自主循环恢复。出院生存率是次要结局变量。
共进行了33例院前急诊开胸手术。10例患者（30%）为枪伤，23例患者（70%）为刺伤。9例患者（27%）恢复了自主循环并被送往医院。其中，1例患者存活至出院且无神经损伤。5例在急诊科或手术室死亡，3例在重症监护室死亡。
因穿透性胸部损伤导致心脏骤停的院外开胸手术后可实现自主循环恢复，但相当数量的患者在院内复苏阶段死亡。然而，可实现神经功能完好的存活。
