From the Department of Surgery (W.B.D., M.A., B.J.G., N.S., B.K., J.A.B., K.I.S.), Riverside Methodist Hospital, Columbus, Ohio; and Department of Surgery (E.A.E.), Medical University of South Carolina, Charleston, South Carolina.
J Trauma Acute Care Surg. 2022 Jan 1;92(1):98-102. doi: 10.1097/TA.0000000000003426.
Cardiopulmonary resuscitation (CPR) contributes to significant chest wall injury similar to blunt trauma. With benefits realized for surgical stabilization of rib fractures (SSRFs) for flail injuries and severely displaced fractures following trauma, SSRF for chest wall injury following CPR could be advantageous, provided good functional and neurologic outlook. Experience is limited. We present a review of patients treated with SSRF at our institution following CPR.
A retrospective analysis of patients undergoing SSRF following CPR was performed between 2019 and 2020. Perioperative inpatient data were collected with outpatient follow-up as able.
Five patients underwent SSRF over the course of the 2-year interval. All patients required invasive ventilation preoperatively or had impending respiratory. Mean age was 59 ± 12 years, with all patients being male. Inciting events for cardiac arrest included respiratory, ventricular tachycardia, ventricular fibrillation, pulseless electrical activity, and anaphylaxis. Time to operation was 6.6 ± 3 days. Four patients demonstrated anterior flail injury pattern with or without sternal fracture, with one patient having multiple severely displaced fractures. Surgical stabilization of rib fracture was performed appropriately to restore chest wall stability. Mean intensive care unit length of stay was 9.8 ± 6.4 days and overall hospital length of stay 24.6 ± 13.2 days. Median postoperative ventilation was 2 days (range, 1-15 days) with two patients developing pneumonia and one requiring tracheostomy. There were no mortalities at 30 days. One patient expired in hospice after a prolonged hospitalization. Disposition destination was variable. No hardware complications were noted on outpatient follow-up, and all surviving patients were home.
Chest wall injuries are incurred frequently following CPR. Surgical stabilization of these injuries can be considered to promote ventilator liberation and rehabilitation. Careful patient selection is paramount, with surgery offered to those with reversible causes of arrest and good functional and neurologic outcome. Experience is early, with further investigation needed.
Therapeutic, Level V.
心肺复苏术（CPR）会导致与钝性创伤相似的显著胸壁损伤。由于外科固定连枷胸肋骨骨折（SSRF）对创伤后连枷胸和严重移位骨折有益，因此对于 CPR 后胸壁损伤进行 SSRF 可能是有利的，前提是患者具有良好的功能和神经预后。目前经验有限。我们介绍了在我们机构接受 CPR 后行 SSRF 治疗的患者。
对 2019 年至 2020 年期间行 SSRF 治疗的 CPR 后患者进行回顾性分析。收集围手术期住院数据，尽可能进行门诊随访。
在 2 年的研究期间，共有 5 例患者接受了 SSRF 治疗。所有患者术前均需要有创通气或存在即将发生的呼吸衰竭。平均年龄为 59 ± 12 岁，均为男性。心脏骤停的诱因包括呼吸、室性心动过速、心室颤动、无脉性电活动和过敏反应。手术时间为 6.6 ± 3 天。4 例患者表现为前连枷胸损伤模式，伴有或不伴有胸骨骨折，1 例患者有多发性严重移位骨折。适当行肋骨骨折固定术以恢复胸壁稳定性。平均重症监护病房住院时间为 9.8 ± 6.4 天，总住院时间为 24.6 ± 13.2 天。中位术后通气时间为 2 天（范围，1-15 天），2 例患者发生肺炎，1 例患者需要行气管切开术。30 天死亡率为 0。1 例患者在长期住院后在临终关怀机构死亡。出院去向各不相同。门诊随访未见内固定物并发症，所有存活患者均已出院回家。
心肺复苏术后常发生胸壁损伤。这些损伤的外科固定可考虑用于促进呼吸机撤离和康复。仔细选择患者至关重要，对于因可逆原因导致的心脏骤停且具有良好功能和神经预后的患者，应考虑手术治疗。目前经验有限，需要进一步研究。
治疗性，5 级。
