创伤性心搏骤停患者的急救医疗服务转运时间与生存的关联：一项全国性回顾性观察研究。
Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study.
机构信息
Department of Emergency, Critical Care, and Disaster Medicine, Dentistry and Pharmaceutical Sciences, Okayama University Graduate School of Medicine, 2-5-1 Shikatacho, Kitaku, Okayama, 700-8558, Japan.
Dentistry and Pharmaceutical Sciences, Department of Epidemiology, Okayama University Graduate School of Medicine, Okayama, Japan.
出版信息
BMC Emerg Med. 2021 Sep 16;21(1):104. doi: 10.1186/s12873-021-00499-z.
BACKGROUND
Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA.
METHODS
A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival.
RESULTS
Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36-70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22-41), and median transport time was 11 min (IQR 6-17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%.
CONCLUSION
The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.
背景
外伤性心脏骤停（TCA）患者预后不良。2003 年，美国急诊医师协会和美国外科医师学会创伤委员会联合提出，在 TCA 后心肺复苏（CPR）持续超过 15 分钟后，停止无效的 CPR。然而，由于缺乏确凿的研究或数据，2013 年取消了复苏的具体时间限制。我们旨在定义急救医疗服务转运时间与存活之间的关联，以展示 TCA 的存活曲线。
方法
回顾性分析日本创伤数据库。纳入标准为年龄≥16 岁，至少有一处创伤的简明损伤量表评分（AIS）≥3，且在院前进行 CPR。排除标准为烧伤、任何区域的 AIS 评分为 6 以及缺失数据。根据所有患者的转运时间分析估计的存活率和存活风险比。还对到达时持续 TCA 的患者分别进行了分析。
结果
在数据库的 292027 名患者中，有 5336 名患者符合研究标准，其中 4141 名患者持续 TCA。他们的中位年龄为 53 岁（四分位距 36-70），67.2%为男性。他们的损伤严重程度评分中位数为 29（四分位距 22-41），中位转运时间为 11 分钟（四分位距 6-17）。TCA 后的总体存活率为 4.5%；然而，到达时持续 TCA 的患者的存活率仅为 1.2%。在 15 分钟的转运时间后，持续 TCA 的估计生存率和风险比迅速下降，估计生存率低于 1%。
结论
在 CPR 支持下转运的同时，持续 TCA 的存活机会迅速下降。虽然临床体征、创伤类型和严重程度应在临床上考虑，但时间应该是考虑终止持续 TCA 患者复苏的一个合理因素。
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