Nevins Edward J, Moori Parisa L, Smith-Williams Jonathan, Bird Nicholas T E, Taylor John V, Misra Nikhil
Emergency General Surgery and Trauma Unit, University Hospital Aintree, Longmoor Lane, Liverpool, L9 7AL, UK.
University of Liverpool Medical School, Liverpool, UK.
Eur J Trauma Emerg Surg. 2018 Dec;44(6):811-818. doi: 10.1007/s00068-018-0937-4. Epub 2018 Mar 21.
The indications for pre-hospital resuscitative thoracotomy (PHRT) remain undefined. The aim of this paper is to explore the variation in practice for PHRT in the UK, and review the published literature.
MEDLINE and PUBMED search engines were used to identify all relevant articles and 22 UK Air Ambulance Services were sent an electronic questionnaire to assess their PHRT practice.
Four European publications report PHRT survival rates of 9.7, 18.3, 10.3 and 3.0% in 31, 71, 39 and 33 patients, respectively. All patients sustained penetrating chest injury. Six case reports also detail survivors of PHRT, again all had sustained penetrating thoracic injury. One Japanese paper presents 34 cases of PHRT following blunt trauma, of which 26.4% survived to the intensive therapy unit but none survived to discharge. A UK population reports a single survivor of PHRT following blunt trauma but the case details remain unpublished. Ten (45%) air ambulance services responded, each service reported different indications for PHRT. All perform PHRT for penetrating chest trauma, however, length of allowed pre-procedure down time varied, ranging from 10 to 20 min. Seventy percent perform PHRT for blunt traumatic cardiac arrest, a procedure which is likely to require aggressive concurrent circulatory support, despite this only 5/10 services carry pre-hospital blood products.
Current indications for PHRT vary amongst different geographical locations, across the UK, and worldwide. Survivors are likely to have sustained penetrating chest injury with short down time. There is only one published survivor of PHRT following blunt trauma, despite this, PHRT is still being performed in the UK for this indication.
院外复苏性开胸手术（PHRT）的适应证仍不明确。本文旨在探讨英国PHRT的实践差异，并回顾已发表的文献。
使用MEDLINE和PUBMED搜索引擎识别所有相关文章，并向22家英国空中救护服务机构发送电子问卷，以评估他们的PHRT实践。
四篇欧洲出版物分别报告了31例、71例、39例和33例患者的PHRT存活率为9.7%、18.3%、10.3%和3.0%。所有患者均遭受穿透性胸部损伤。六篇病例报告也详细介绍了PHRT的幸存者，同样所有人都遭受了穿透性胸部损伤。一篇日本论文介绍了34例钝性创伤后进行PHRT的病例，其中26.4%存活至重症监护病房，但无一例存活至出院。英国有一篇报道称有一名钝性创伤后PHRT的幸存者，但病例细节尚未发表。十家（45%）空中救护服务机构做出了回应，每家机构报告的PHRT适应证不同。所有机构都对穿透性胸部创伤进行PHRT，然而，允许的术前停机时间各不相同，从10分钟到20分钟不等。70%的机构对钝性创伤性心脏骤停进行PHRT，尽管这一手术可能需要积极的同步循环支持，但只有5/10的机构配备了院前血液制品。
目前PHRT的适应证在不同地理位置、英国各地以及全球范围内都有所不同。幸存者可能遭受了穿透性胸部损伤且停机时间较短。钝性创伤后PHRT仅有一例已发表的幸存者，尽管如此，在英国仍有机构因这一适应证进行PHRT。
