Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Allied Medical Sciences, Jordan University of Science and Technology, Irbid, Jordan.
Department of Paramedicine, Monash University, Frankston, Victoria, Australia; Department of Epidemiology and Preventive Medicine, Monash University, Melbourne, Victoria, Australia; Centre for Research and Evaluation, Ambulance Victoria, Blackburn North, Victoria, Australia.
Resuscitation. 2021 May;162:104-111. doi: 10.1016/j.resuscitation.2021.02.026. Epub 2021 Feb 22.
In this study, we examine the impact of a trauma-focused resuscitation protocol on survival outcomes following adult traumatic out-of-hospital cardiac arrest (OHCA).
We included adult traumatic OHCA patients aged >16 years occurring between 2008 and 2019. In December 2016, a new resuscitation protocol for traumatic OHCA was introduced prioritising the treatment of potentially reversible causes before conventional cardiopulmonary resuscitation (CPR). The effect of the new protocol on survival outcomes was assessed using adjusted interrupted time series regression.
Over the study period, paramedics attempted resuscitation on 996 patients out of 3,958 attended cases. Of the treated cases, 672 (67.5%) and 324 (32.5%) occurred during pre-intervention and intervention periods, respectively. The frequency of almost all trauma interventions was significantly higher in the intervention period, including external haemorrhage control (15.7% vs 7.6; p-value <0.001), blood administration (3.8% vs 0.2%; p-value <0.001), and needle thoracostomy (75.9% vs 42.0%; p-value <0.001). There was also a significant reduction in the median time from initial patient contact to the delivery of needle thoracostomy (4.4 min vs 8.7 min; p-value <0.001) and splinting (8.7 min vs 17.5 min; p-value = 0.009). After adjustment, the trauma-focused resuscitation protocol was not associated with a change in the level of survival to hospital discharge (adjusted odds ratio [AOR] 0.98; 95% confidence interval [CI]: 0.11-8.59), event survival (AOR 0.82; 95% CI: 0.33-2.03), or prehospital return of spontaneous circulation (AOR 1.30; 95% CI: 0.61-2.76).
Despite an increase in trauma-based interventions and a reduction in the time to their administration, our study did not find a survival benefit from a trauma-focused resuscitation protocol over initial conventional CPR. However, survival was low with both approaches.
本研究旨在探讨创伤为中心的复苏方案对成人创伤性院外心脏骤停（OHCA）患者生存结局的影响。
我们纳入了 2008 年至 2019 年期间发生的年龄大于 16 岁的成人创伤性 OHCA 患者。2016 年 12 月，引入了一种新的创伤性 OHCA 复苏方案，该方案优先治疗潜在可逆转的病因，然后再进行传统心肺复苏（CPR）。使用调整后的中断时间序列回归评估新方案对生存结局的影响。
在研究期间，急救人员对 3958 例到场病例中的 996 例患者进行了复苏尝试。在治疗病例中，分别有 672 例（67.5%）和 324 例（32.5%）发生在干预前和干预期间。干预期间几乎所有创伤干预措施的频率均显著升高，包括外部出血控制（15.7%比 7.6%；p 值<0.001）、输血（3.8%比 0.2%；p 值<0.001）和针式胸腔穿刺术（75.9%比 42.0%；p 值<0.001）。从首次接触患者到实施针式胸腔穿刺术（4.4 分钟比 8.7 分钟；p 值<0.001）和夹板固定（8.7 分钟比 17.5 分钟；p 值=0.009）的中位时间也显著缩短。调整后，创伤为中心的复苏方案与住院出院生存率（调整后的优势比[OR]0.98；95%置信区间[CI]：0.11-8.59）、事件生存率（OR 0.82；95%CI：0.33-2.03）或院前自主循环恢复率（OR 1.30；95%CI：0.61-2.76）均无相关性。
尽管创伤相关干预措施增加，且实施时间缩短，但我们的研究并未发现创伤为中心的复苏方案相对于初始常规 CPR 具有生存优势。然而，两种方法的生存率均较低。
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