Dickson Robert L, Gleisberg Guy, Aiken Michael, Crocker Kevin, Patrick Casey, Nichols Tyler, Mason Christopher, Fioretti Joseph
Baylor College of Medicine, Baylor University, Houston, Texas.
Houston Fire Department, Houston, Texas.
J Emerg Med. 2018 Sep;55(3):366-371. doi: 10.1016/j.jemermed.2018.05.027. Epub 2018 Jun 28.
Tube thoracostomy has long been the standard of care for treatment of tension pneumothorax in the hospital setting yet is uncommon in prehospital care apart from helicopter emergency medical services.
We aimed to evaluate the performance of simple thoracostomy (ST) for patients with traumatic cardiac arrest and suspected tension pneumothorax.
We conducted a retrospective case series of consecutive patients with traumatic cardiac arrest where simple thoracostomy was used during the resuscitation effort. Data were abstracted from our Zoll emergency medical record (Zoll Medical Corp., Chelmsford, MA) for patients who received the procedure between June 1, 2013 and July 1, 2017. We collected general descriptive characteristics, procedural success, presence of air or blood, and outcomes for each patient.
During the study period we performed ST on 57 patients. The mean age was 41 years old (range 15-81 years old) and 83% were male. Indications included 40 of 57 (70%) blunt trauma and 17 of 57 (30%) penetrating trauma. The presenting rhythm was pulseless electrical activity 65%, asystole 26%, ventricular tachycardia/fibrillation 4%, and nonrecorded 5%. Eighteen of 57 (32%) had air return, 14 of 57 (25%) return of spontaneous circulation, with 6 of 57 (11%) surviving to 24 h and 4 of 57 (7%) discharged from the hospital neurologically intact. Of the survivors, all were blunt trauma mechanism with initial rhythms of pulseless electrical activity. There were no reported medic injuries.
Our data show that properly trained paramedics in ground-based emergency medical services were able to safely and effectively perform ST in patients with traumatic cardiac arrest. We found a significant (32%) presence of pneumothorax in our sample, which supports previously reported high rates in this patient population.
胸腔闭式引流长期以来一直是医院环境中治疗张力性气胸的标准治疗方法，但在院前急救中并不常见，直升机紧急医疗服务除外。
我们旨在评估简易胸腔造口术（ST）对创伤性心脏骤停并疑似张力性气胸患者的治疗效果。
我们对一系列连续的创伤性心脏骤停患者进行了回顾性病例研究，这些患者在复苏过程中接受了简易胸腔造口术。数据来自我们的Zoll急救医疗记录（Zoll Medical Corp.，马萨诸塞州切尔姆斯福德），对象为2013年6月1日至2017年7月1日期间接受该手术的患者。我们收集了每位患者的一般描述性特征、手术成功率、是否有气体或血液以及治疗结果。
在研究期间，我们对57例患者进行了简易胸腔造口术。平均年龄为41岁（范围15 - 81岁），83%为男性。适应症包括57例中的40例（70%）钝性创伤和57例中的17例（30%）穿透性创伤。呈现的心律为无脉电活动65%，心脏停搏26%，室性心动过速/心室颤动4%，未记录5%。57例中有18例（32%）有气体回流，57例中有14例（25%）恢复自主循环，57例中有6例（11%）存活至24小时，57例中有4例（7%）出院时神经功能完好。在幸存者中，均为钝性创伤机制，初始心律为无脉电活动。没有报告医疗人员受伤情况。
我们的数据表明，在地面紧急医疗服务中经过适当培训的护理人员能够安全有效地对创伤性心脏骤停患者进行简易胸腔造口术。我们发现样本中气胸的发生率很高（32%），这支持了先前报道的该患者群体中的高发生率。
