高级院前复苏治疗：我们能否确定可能受益的创伤患者？

Advanced prehospital resuscitative care: Can we identify trauma patients who might benefit?

机构信息

From the Center for Injury Science (A.I., K.J., P.A., W.A.S., S.W.S., R.L.G., W.W., S.L.C., D.R., J.B.H., J.O.J.), University of Alabama at Birmingham, Birmingham; Center Point Fire District (W.W.), Center Point, Alabama; Bessemer Fire Department (R.H.), Bessemer, Alabama; and Department of Emergency Medicine (Z.Q.), Perelman School of Medicine at the University of Pennsylvania, Philadelphia, Pennsylvania.

出版信息

J Trauma Acute Care Surg. 2021 Sep 1;91(3):514-520. doi: 10.1097/TA.0000000000003277.

DOI:10.1097/TA.0000000000003277

PMID:33990533

Abstract

BACKGROUND

Uncontrolled truncal hemorrhage remains the most common cause of potentially preventable death after injury. The notion of earlier hemorrhage control and blood product resuscitation is therefore attractive. Some systems have successfully implemented prehospital advanced resuscitative care (ARC) teams. Early identification of patients is key and is reliant on rapid decision making and communication. The purpose of this simulation study was to explore the feasibility of early identification of patients who might benefit from ARC in a typical US setting.

METHODS

We conducted a prospective observational/simulation study at a level I trauma center and two associated emergency medical service (EMS) agencies over a 9-month period. The participating EMS agencies were asked to identify actual patients who might benefit from the activation of a hypothetical trauma center-based ARC team. This decision was then communicated in real time to the study team.

RESULTS

Sixty-three patients were determined to require activation. The number of activations per month ranged from 2 to 15. The highest incidence of calls occurred between 4 pm to midnight. Of the 63 patients, 33 were transported to the trauma center. The most common presentation was with penetrating trauma. The median age was 27 years (interquartile range, 24-45 years), 75% were male, and the median Injury Severity Score was 11 (interquartile range, 7-20). Based on injury patterns, treatment received, and outcomes, it was determined that 6 (18%) of 33 patients might have benefited from ARC. Three of the patients died en-route to or soon after arrival at the trauma center.

CONCLUSION

The prehospital identification of patients who might benefit from ARC is possible but faces challenges. Identifying strategies to adapt existing processes may allow better utilization of the existing infrastructure and should be a focus of future efforts.

LEVEL OF EVIDENCE

Prognostic/Epidemiologic, level III.

摘要

背景

在创伤后，无法控制的躯干出血仍然是最常见的潜在可预防死亡原因。因此，尽早控制出血和输血复苏的概念很有吸引力。一些系统已经成功实施了院前高级复苏护理 (ARC) 团队。早期识别患者是关键，这依赖于快速的决策和沟通。本模拟研究的目的是探索在典型的美国环境中早期识别可能受益于 ARC 的患者的可行性。

方法

我们在一家一级创伤中心和两个相关的紧急医疗服务 (EMS) 机构进行了一项前瞻性观察/模拟研究，历时 9 个月。要求参与的 EMS 机构识别可能受益于假设的创伤中心基于 ARC 团队激活的实际患者。然后，该决策实时传达给研究团队。

结果

确定需要激活的患者有 63 例。每月的激活次数从 2 次到 15 次不等。呼叫次数最高的时间段是下午 4 点到午夜。在 63 例患者中，有 33 例被送往创伤中心。最常见的表现是穿透性创伤。中位数年龄为 27 岁（四分位距，24-45 岁），75%为男性，损伤严重程度评分中位数为 11（四分位距，7-20）。根据损伤模式、接受的治疗和结果，确定 33 例患者中的 6 例（18%）可能受益于 ARC。其中 3 例患者在送往创伤中心的途中或到达后不久死亡。