心肺复苏引起的胸壁损伤及其对院外心脏骤停存活者住院结局的影响。
Chest wall injuries due to cardiopulmonary resuscitation and the effect on in-hospital outcomes in survivors of out-of-hospital cardiac arrest.
机构信息
From the Trauma Research Unit Department of Surgery (J.T.H.P., E.M.M.V.L., S.F.M.V.W., M.H.J.V., M.M.E.W.), Department of Clinical Epidemiology of Cardiovascular Diseases (N.T.B.S.), Department of Intensive Care (C.A.D.U.), and Department of Cardiology (C.A.D.U.), Erasmus MC, University Medical Center Rotterdam; and Department of Surgery (J.V.), Maasstad Ziekenhuis, Rotterdam, the Netherlands.
出版信息
J Trauma Acute Care Surg. 2021 Dec 1;91(6):966-975. doi: 10.1097/TA.0000000000003379.
BACKGROUND
This study aimed to assess the prevalence of chest wall injuries due to cardiopulmonary resuscitation for out-of-hospital cardiac arrest (OHCA) and to compare in-hospital outcomes in patients with versus without chest wall injuries.
METHODS
A retrospective cohort study of all intensive care unit (ICU)-admitted patients who underwent cardiopulmonary resuscitation for OHCA between January 1, 2007, and December 2019 was performed. The primary outcome was the occurrence of chest wall injuries, as diagnosed on chest computed tomography. Chest wall injury characteristics such as rib fracture location, type, and dislocation were collected. Secondary outcomes were in-hospital outcomes and subgroup analysis of patients with good neurological recovery to identify those who could possibly benefit from the surgical stabilization of rib fractures.
RESULTS
Three hundred forty-four patients were included, of which 291 (85%) sustained chest wall injury. Patients with chest wall injury had a median of 8 fractured ribs (P25-P75, 4-10 ribs), which were most often undisplaced (on chest computed tomography) (n = 1,574 [72.1%]), simple (n = 1,948 [89.2%]), and anterior (n = 1,785 [77.6%]) rib fractures of ribs 2 to 7. Eight patients (2.3%) had a flail segment, and 136 patients (39.5%) had an anterior flail segment. Patients with chest wall injury had fewer ventilator-free days (0 days [P25-P75, 0-16 days] vs. 13 days [P25-P75, 2-22 days]; p = 0.006) and a higher mortality rate (n = 102 [54.0%] vs. n = 8 [22.2%]; p < 0.001) than those without chest wall injury. For the subgroup of patients with good neurological recovery, the presence of six or more rib fractures or a single displaced rib fracture was associated with longer hospital and ICU length of stay, respectively.
CONCLUSION
Cardiopulmonary resuscitation-related chest wall injuries in survivors of OHCA and especially rib fractures are common. Patients with chest wall injury had fewer ventilator-free days and a higher mortality rate. Patients with good neurological recovery might represent a subgroup of patients who could benefit from surgical stabilization of rib fractures.
LEVEL OF EVIDENCE
Therapeutic, level IV; Epidemiological, Level IV.
背景
本研究旨在评估心肺复苏（CPR）治疗院外心脏骤停（OHCA）导致的胸壁损伤的发生率，并比较伴有和不伴有胸壁损伤的患者的院内结局。
方法
对 2007 年 1 月 1 日至 2019 年 12 月期间接受 OHCA 后行 ICU 治疗的所有 ICU 入院患者进行了回顾性队列研究。主要结局为通过胸部 CT 诊断的胸壁损伤的发生。收集了胸壁损伤特征，如肋骨骨折部位、类型和脱位。次要结局为院内结局，并对神经功能良好恢复的患者进行亚组分析，以确定可能受益于肋骨骨折手术固定的患者。
结果
共纳入 344 例患者，其中 291 例（85%）发生胸壁损伤。有胸壁损伤的患者肋骨骨折中位数为 8 根（P25-P75，4-10 根），大多数为无移位（胸部 CT 上）（n = 1574[72.1%]）、单纯性（n = 1948[89.2%]）和前（n = 1785[77.6%]）肋骨 2-7 骨折。8 例（2.3%）患者有浮动段，136 例（39.5%）患者有前浮动段。有胸壁损伤的患者无呼吸机天数较少（0 天[P25-P75，0-16 天] vs. 13 天[P25-P75，2-22 天]；p = 0.006），死亡率较高（n = 102[54.0%] vs. n = 8[22.2%]；p < 0.001）。对于神经功能良好恢复的亚组患者，6 根或更多肋骨骨折或单一移位肋骨骨折分别与更长的住院和 ICU 住院时间相关。
结论
OHCA 幸存者中 CPR 相关的胸壁损伤，尤其是肋骨骨折很常见。有胸壁损伤的患者无呼吸机天数较少，死亡率较高。神经功能良好恢复的患者可能代表了一组可能受益于肋骨骨折手术固定的患者。
证据水平
治疗，IV 级；流行病学，IV 级。
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