Department of Surgery, University of Florida Health, Gainesville, FL.
Department of Surgery, University of Florida Health, Gainesville, FL.
J Am Coll Surg. 2021 Apr;232(4):560-570. doi: 10.1016/j.jamcollsurg.2020.11.008. Epub 2020 Nov 20.
Early hemorrhage control is essential to optimal trauma care. Hybrid operating rooms offer early, concomitant performance of advanced angiographic and operative hemostasis techniques, but their clinical impact is unclear. Herein, we present our initial experience with a dedicated, trauma hybrid operating room.
This retrospective cohort analysis of 292 adult trauma patients undergoing immediate surgery at a Level I trauma center compared patients managed after implementation of a dedicated, trauma hybrid operating room (n = 186) with historic controls (n = 106). The primary outcomes were time to hemorrhage control (systolic blood pressure ≥ 100 mmHg without ongoing vasopressor or transfusion requirements), early blood product administration, and complication.
Patient characteristics were similar between cohorts (age 41 years, 25% female, 38% penetrating trauma). The hybrid cohort had lower initial hemoglobin (10.2 vs 11.1 g/dL, p = 0.001) and a greater proportion of patients undergoing resuscitative endovascular balloon occlusion of the aorta (9% vs 1%, p = 0.007). Cohorts had similar case mixes and intraoperative consultation with cardiothoracic or vascular surgery (13%). Twenty-one percent of all hybrid cases included angiography. The interval between operating room arrival and hemorrhage control was shorter in the hybrid cohort (49 vs 60 minutes, p = 0.005). From 4 to 24 hours after arrival, the hybrid cohort had fewer red cell (0.0 vs 1.0, p = 0.001) and plasma transfusions (0.0 vs 1.0, p < 0.001). The hybrid cohort had fewer infectious complications (15% vs 27%, p = 0.009) and ventilator days (2.0 vs 3.0, p = 0.011), and similar in-hospital mortality (13% vs 10%, p = 0.579).
Implementation of a dedicated, trauma hybrid operating room was associated with earlier hemorrhage control and fewer early blood transfusions, infectious complications, and ventilator days.
早期出血控制对于最佳创伤护理至关重要。杂交手术室提供了早期同时进行高级血管造影和手术止血技术的机会，但它们的临床影响尚不清楚。在此，我们介绍了我们在专门的创伤杂交手术室中的初步经验。
这是一项对在一级创伤中心接受立即手术的 292 例成年创伤患者的回顾性队列分析，比较了在专门的创伤杂交手术室实施后（n=186）与历史对照组（n=106）的患者。主要结局是出血控制时间（收缩压≥100mmHg，无需持续使用血管加压药或输血）、早期血制品的应用和并发症。
两组患者的特征相似（年龄 41 岁，25%为女性，38%为穿透性创伤）。杂交组的初始血红蛋白水平较低（10.2 与 11.1g/dL，p=0.001），主动脉复苏性血管内球囊阻断术的患者比例更高（9%与 1%，p=0.007）。两组患者的病例组合和心胸血管外科或血管外科的术中咨询（13%）相似。所有杂交病例中有 21%包括血管造影。杂交组从手术室到达到出血控制的时间更短（49 与 60 分钟，p=0.005）。在到达后的 4 至 24 小时，杂交组的红细胞（0.0 与 1.0，p=0.001）和血浆输注量（0.0 与 1.0，p<0.001）更少。杂交组的感染并发症较少（15%与 27%，p=0.009），呼吸机使用天数较少（2.0 与 3.0，p=0.011），院内死亡率相似（13%与 10%，p=0.579）。
实施专门的创伤杂交手术室与早期出血控制和早期输血、感染并发症和呼吸机使用天数减少相关。
