R Adams Cowley Shock Trauma Center, University of Maryland, Baltimore, Maryland.
University of Tennessee, Memphis, Tennessee.
Shock. 2018 Oct;50(4):414-420. doi: 10.1097/SHK.0000000000001091.
Several reviews of resuscitative thoracotomy (RT) use over the last five decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared with historical data (n = 10,238) from the EAST PMG review from published series 1974 to 2013.
The American Association for the Surgery of Trauma Aortic Occlusion for Trauma and Acute Care Surgery (AORTA) registry was utilized to identify patients undergoing RT in the emergency department (ED) from November 2013 to December 2016. Demographics, injury data, physiologic presentation, and outcomes were reviewed and compared with those of the EAST PMG review.
Three-hundred ten RT patients from 16 contributing AORTA centers were identified. The majority were injured by penetrating mechanisms (197/310, 64% [gunshot (163/197, 83%)]). Signs of life (SOL) (organized electrical activity, pupillary response, spontaneous movement, or appreciable pulse/blood pressure) were present on arrival in 47% (147/310). When compared with the EAST PMG results, there was no difference in either hospital survival (5% vs. 8%) or neurologically intact survival between historical controls or AORTA registry patients in any category combination of mechanism/anatomic location/presenting signs of life. Blunt injuries W/O SOL on admission continue to constitute 14% (45/310) of RTs in the ED, without documented survivors.
Comparison of historical RT controls to more contemporary patients from the AORTA registry suggests that practices and outcomes following RT have not changed. Despite a wealth of accumulated data over several decades, RT continues to be performed for patients after blunt mechanisms of injury who present W/O SOL despite lack of demonstrated hope for survival benefit.
过去五十年中已经对复苏性开胸术（RT）的使用进行了几次审查，最近是东部创伤外科学会（EAST）的循证实践管理指南（PMG）。本研究旨在检查与历史数据（1974 年至 2013 年发表的 EAST PMG 综述中 n = 10,238）相比，当代 RT 的使用情况和结果。
利用美国创伤外科协会主动脉闭塞治疗创伤和急性外科治疗（AORTA）登记处，从 2013 年 11 月至 2016 年 12 月，在急诊科（ED）识别接受 RT 的患者。回顾并比较了人口统计学、损伤数据、生理表现和结局与 EAST PMG 综述的结果。
从 16 个参与 AORTA 中心的 310 例 RT 患者中确定。大多数是由穿透性机制受伤（197/310，64%[枪伤（163/197，83%）]）。到达时存在生命迹象（SOL）（有组织的电活动、瞳孔反应、自主运动或可感知的脉搏/血压）占 47%（147/310）。与 EAST PMG 结果相比，在任何机制/解剖部位/出现 SOL 的生命迹象的组合类别中，历史对照或 AORTA 登记处患者的医院存活率（5%与 8%）或神经完整存活率均无差异。入院时 SOL 不存在的钝性损伤继续占 ED 中 RT 的 14%（45/310），无存活记录。
将历史 RT 对照与 AORTA 登记处的更现代患者进行比较表明，RT 后的实践和结果没有改变。尽管过去几十年积累了大量数据，但 RT 仍继续对钝性损伤机制后的患者进行，尽管缺乏生存获益的证据，但患者仍无 SOL 出现。
