早期和院前创伤死亡：谁可能受益于高级复苏治疗？
Early and prehospital trauma deaths: Who might benefit from advanced resuscitative care?
机构信息
From the Center for Injury Science (S.L.C., W.A.S., S.W.S., D.A.R., J.D.K., J.B.H. J.O.J.), and Department of Pathology (D.W.D.), University of Alabama at Birmingham, Birmingham, Alabama, Birmingham, Alabama.
出版信息
J Trauma Acute Care Surg. 2020 Jun;88(6):776-782. doi: 10.1097/TA.0000000000002657.
BACKGROUND
Recent civilian and military data from the United States and the United Kingdom suggest that further reductions in mortality will require prehospital or preoperating room hemorrhage control and blood product resuscitation. The aims of this study were to examine the potential preventability of prehospital and early in-hospital fatalities, and to consider the geographical location of such incidents, to contextualize how the use of advanced resuscitative techniques could be operationalized.
METHODS
Retrospective analysis of prehospital and early in-hospital trauma deaths from January to December 2017. Data were obtained from the Coroner/ME's Office. Each death was reviewed by a panel of two trauma surgeons and a forensic pathologist. Anatomical and physiological survivabilities were evaluated separately, and then combined, leading to a holistic assessment of preventability. Incident locations were mapped and analyzed using ArcGIS.
RESULTS
Three hundred sixteen trauma deaths were identified. Two hundred thirty-one (73%) were deemed anatomically not survivable; 29 (9%) anatomically survivable, but only with hospital care; 43 (14%) anatomically survivable with advanced prehospital care; and 13 (4%) anatomically survivable with basic prehospital care. Physiologically, 114 (36%) of the patients had been dead for some time when found; 137 (43%) had no cardiorespiratory effort on arrival of Emergency Medical Services (EMS) at the scene; 24 (8%) had cardiorespiratory effort at the scene, but not on arrival at the emergency department; and 41 (13%) had cardiorespiratory effort on arrival at the emergency department, but died shortly after. Combining the assessments, 10 (3%) deaths were deemed probably not preventable, 38 (12%) possibly preventable, and the remaining 278 (85%) not preventable.
CONCLUSION
Twelve percent of trauma deaths were potentially preventable and might be amenable to advanced resuscitative interventions. Operationalizing this type of care will be challenging and will require either prehospital doctors, or very highly trained paramedics, nurses, or physician assistants.
LEVEL OF EVIDENCE
Epidemiological, level III.
背景
来自美国和英国的最近的民用和军事数据表明，进一步降低死亡率将需要在院前或手术前进行出血控制和血液制品复苏。本研究的目的是检查院前和早期院内死亡的潜在可预防性，并考虑此类事件的地理位置，以了解如何实施先进的复苏技术。
方法
对 2017 年 1 月至 12 月期间的院前和早期院内创伤死亡进行回顾性分析。数据来自验尸官/ ME 办公室。每位死者均由两名创伤外科医生和一名法医病理学家组成的小组进行审查。分别评估解剖学和生理学的生存能力，然后将其合并，以全面评估可预防程度。使用 ArcGIS 对事件地点进行映射和分析。
结果
确定了 316 例创伤死亡。231 例（73%）被认为在解剖学上无法存活；29 例（9%）在解剖学上可存活，但仅在医院治疗；43 例（14%）在先进的院前治疗中可存活；13 例（4%）在基本的院前治疗中可存活。从生理学上讲，发现时 114 例（36%）患者已经死亡一段时间；137 例（43%）到达现场时紧急医疗服务（EMS）没有心肺复苏努力；24 例（8%）在现场有心肺复苏努力，但到达急诊室时没有；41 例（13%）到达急诊室时具有心肺复苏努力，但随后不久死亡。综合评估，有 10 例（3%）死亡被认为可能无法预防，38 例（12%）可能可以预防，其余 278 例（85%）无法预防。
结论
12%的创伤死亡是潜在可预防的，可能适合进行先进的复苏干预。实施这种类型的护理将具有挑战性，需要院前医生，或者经过高度培训的护理人员、护士或医师助理。
证据水平
流行病学，三级。
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