Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon.
Department of Emergency Medicine, American University of Beirut Medical Center, Beirut, Lebanon; Emergency Medical Services and Prehospital Care Program, American University of Beirut Medical Center, Beirut, Lebanon.
J Emerg Med. 2020 Aug;59(2):169-177. doi: 10.1016/j.jemermed.2020.05.005. Epub 2020 Jun 24.
Emergency department thoracotomy (EDT) is done to control life threatening hemorrhage and injuries. Literature examining this topic is limited to relatively small studies from single trauma centers.
This study identifies factors associated with survival to hospital discharge of patients undergoing EDT using the largest U.S. national trauma database.
This retrospective cohort study used the U.S. National Trauma Data Bank 2015. We conducted univariate and bivariate analyses followed by a multivariate analysis that adjusted for confounders to identify factors associated with survival.
Two thousand four hundred eighty-six patients who underwent EDT were included. Most patients were 16 to 64 years of age (92.3%) with a male predominance (84.9%) and without any previous comorbidities (62.8%). Penetrating injury was most common (60.2%), mainly as a result of assault (51.0%) by firearm (45.1%). Overall survival to hospital discharge was 38.2%. After adjusting for confounders, factors associated with increased survival were cut/piece injuries, presenting with signs of life, Glasgow Coma Scale score ≥8, systolic blood pressure >90 mm Hg, and transportation to the ED through helicopter/fixed-wing ambulance or public/private vehicle (reference, ground ambulance).
Factors associated with survival in patients undergoing EDT were identified. The clinical indication of presence of appropriate resources to continue and repair EDT was validated, along with the contraindications of lack of signs of life and presence of major nonsurvivable injuries. Future studies should focus on validation of all criteria of EDT, namely hemodynamic instability despite appropriate fluid resuscitation, duration of time of cardiopulmonary resuscitation and pulselessness, cardiac rhythm on arrival, and the presence of pericardial tamponade.
急诊开胸术 (EDT) 用于控制威胁生命的出血和损伤。检查这一主题的文献仅限于来自单一创伤中心的相对较小的研究。
本研究使用美国最大的国家创伤数据库，确定接受 EDT 的患者存活至出院的相关因素。
这是一项回顾性队列研究，使用了美国国家创伤数据库 2015 年的数据。我们进行了单变量和双变量分析，然后进行了多变量分析，调整了混杂因素，以确定与存活相关的因素。
共纳入 2486 例接受 EDT 的患者。大多数患者年龄在 16 至 64 岁之间（92.3%），男性居多（84.9%），且无任何先前的合并症（62.8%）。穿透性损伤最为常见（60.2%），主要由枪击伤（51.0%）所致，其中 45.1%为火器伤。总体存活率为 38.2%。调整混杂因素后，与生存率提高相关的因素包括切割/撕裂伤、有生命迹象、格拉斯哥昏迷评分≥8、收缩压>90mmHg 以及通过直升机/固定翼救护车或公共/私人车辆（参照，地面救护车）送往急诊室。
确定了接受 EDT 的患者存活的相关因素。验证了存在适当资源继续进行并修复 EDT 的临床指征，以及无生命迹象和存在不可存活的主要损伤的禁忌症。未来的研究应集中于验证所有 EDT 标准，即尽管进行了适当的液体复苏，仍存在血流动力学不稳定、心肺复苏时间和无脉时间、到达时的心脏节律以及心包填塞的存在。
