Department of Gastrointestinal Surgery, Stavanger University Hospital, P.O. Box 8100, 4068, Stavanger, Norway.
Section for Traumatology, Surgical Clinic, Stavanger University Hospital, Stavanger, Norway.
World J Surg. 2021 May;45(5):1340-1348. doi: 10.1007/s00268-021-05980-1. Epub 2021 Feb 10.
Resuscitative emergency thoracotomy is a potential life-saving procedure but is rarely performed outside of busy trauma centers. Yet the intervention cannot be deferred nor centralized for critically injured patients presenting in extremis. Low-volume experience may be mitigated by structured training. The aim of this study was to describe concurrent development of training and simulation in a trauma system and associated effect on one time-critical emergency procedure on patient outcome.
An observational cohort study split into 3 arbitrary time-phases of trauma system development referred to as 'early', 'developing' and 'mature' time-periods. Core characteristics of the system is described for each phase and concurrent outcomes for all consecutive emergency thoracotomies described with focus on patient characteristics and outcome analyzed for trends in time.
Over the study period, a total of 36 emergency thoracotomies were performed, of which 5 survived (13.9%). The "early" phase had no survivors (0/10), with 2 of 13 (15%) and 3 of 13 (23%) surviving in the development and mature phase, respectively. A decline in 'elderly' (>55 years) patients who had emergency thoracotomy occurred with each time period (from 50%, 31% to 7.7%, respectively). The gender distribution and the injury severity scores on admission remained unchanged, while the rate of patients with signs on life (SOL) increased over time.
The improvement over time in survival for one time-critical emergency procedure may be attributed to structured implementation of team and procedure training. The findings may be transferred to other low-volume regions for improved trauma care.
复苏性紧急开胸术是一种潜在的救生程序，但在繁忙的创伤中心之外很少进行。然而，对于处于危急状态的重伤患者，不能推迟或集中进行干预。低容量的经验可以通过结构化培训来减轻。本研究的目的是描述创伤系统中培训和模拟的同时发展以及对一项关键时间紧急程序对患者结局的影响。
本研究采用观察性队列研究，将创伤系统的发展分为三个任意时间阶段，分别称为“早期”、“发展中”和“成熟”时期。描述了每个阶段的系统核心特征，并对所有连续的紧急开胸术进行了并发结果描述，重点关注患者特征和随时间的结果分析趋势。
在研究期间，共进行了 36 例紧急开胸术，其中 5 例存活（13.9%）。“早期”阶段没有存活者（0/10），“发展中”和“成熟”阶段分别有 2 例（15%）和 3 例（23%）存活。每个时间段进行紧急开胸术的“老年”（>55 岁）患者数量均有所下降（分别为 50%、31%和 7.7%）。性别分布和入院时的损伤严重程度评分保持不变，而有生命体征（SOL）的患者比例随时间增加。
一项关键时间紧急程序的生存时间的改善可能归因于团队和程序培训的结构化实施。这些发现可以转移到其他低容量地区，以改善创伤护理。
