DuBose Joseph J, Stinner Daniel J, Baudek Aric, Martens Daniel, Donham Benjamin, Cuthrell Matthew, Stephens Tony, Schofield Jerry, Conklin Curtis C, Telian Simon
J Spec Oper Med. 2020 Winter;20(4):47-52. doi: 10.55460/SI6S-XHCZ.
Expedient resuscitation and emergent damage control interventions remain critical tools of modern combat casualty care. Although fortunately rare, the requirement for life and limb salvaging surgical intervention prior to arrival at traditional deployed medical treatment facilities may be required for the care of select casualties. The optimal employment of a surgical resuscitation team (SRT) may afford life and limb salvage in these unique situations.
Fifteen years of after-action reports (AARs) from a highly specialized SRTs were reviewed. Patient demographics, specific details of encounter, team role, advanced emergent life and limb interventions, and outcomes were analyzed.
Data from 317 casualties (312 human, five canines) over 15 years were reviewed. Among human casualties, 20 had no signs of life at intercept, with only one (5%) surviving to reach a Military Treatment Facility (MTF). Among the 292 casualties with signs of life at intercept, SRTs were employed in a variety of roles, including MTF augmentation (48.6%), as a transport capability from other aeromedical platforms, critical care transport (CCT) between MTFs (27.7%), or as an in-flight damage control capability directly to point of injury (POI) (18.2%). In the context of these roles, the SRT performed in-flight life and limb preserving surgery for nine patients. Procedures performed included resuscitative thoracotomy (7/9; 77.8%), damage control laparotomy (1/9; 11.1%) and extremity fasciotomy for acute lower extremity compartment syndrome (1/11; 11%). Survival following in-flight resuscitative thoracotomy was 33% (1/3) when signs of life (SOL) were absent at intercept and 75% (3/4) among patients who lost SOL during transport.
In-flight surgery by a specifically trained and experienced SRT can salvage life and limb for casualties of major combat injury. Additional research is required to determine optimal SRT utilization in present and future conflicts.
快速复苏和紧急损伤控制干预仍然是现代战斗伤员救治的关键手段。虽然幸运的是这种情况很少见，但对于某些伤员的救治，可能需要在抵达传统部署的医疗设施之前进行挽救生命和肢体的手术干预。在这些特殊情况下，优化使用外科复苏团队（SRT）可能有助于挽救生命和肢体。
回顾了一个高度专业化SRT的15年行动后报告（AAR）。分析了患者人口统计学、具体遭遇细节、团队角色、高级紧急生命和肢体干预措施以及结果。
回顾了15年间317例伤员（312例人类，5例犬类）的数据。在人类伤员中，20例在拦截时无生命迹象，只有1例（5%）存活至抵达军事治疗机构（MTF）。在拦截时有生命迹象的292例伤员中，SRT发挥了多种作用，包括加强MTF（48.6%）、作为从其他航空医疗平台的运输能力、MTF之间的重症监护运输（CCT）（27.7%）或作为直接前往受伤点（POI）的飞行中的损伤控制能力（18.2%）。在这些角色中，SRT为9例患者进行了飞行中的生命和肢体保全手术。实施的手术包括复苏性开胸手术（7/9；77.8%）、损伤控制剖腹手术（1/9；11.1%）和针对急性下肢筋膜室综合征的肢体筋膜切开术（1/11；11%）。拦截时无生命迹象（SOL）的患者飞行中复苏性开胸手术后的存活率为33%（1/3），运输过程中失去SOL的患者中这一比例为75%（3/4）。
经过专门训练且经验丰富的SRT进行的飞行中手术可以挽救重伤战斗伤员的生命和肢体。需要进一步研究以确定在当前和未来冲突中SRT的最佳使用方式。
