Fierro Nicole M, Dhillon Navpreet K, Yong Felix A, Muniz Tobias, Siletz Anaar E, Barmparas Galinos, Ley Eric J
Department of Surgery, 22494Cedars-Sinai Medical Center, Los Angeles, CA, USA.
Am Surg. 2022 Oct;88(10):2464-2469. doi: 10.1177/00031348221101500. Epub 2022 May 13.
Although indications and outcomes for trauma patients who require resuscitative thoracotomies are well studied, little is known about how prehospital chest compressions support survival in patients who do not meet criteria for subsequent resuscitative thoracotomy.
Data from a single institutional retrospective review of trauma patients who required prehospital chest compressions from 1/2015 to 12/2020 were collected. Patients who underwent compressions only were compared to those who underwent subsequent resuscitative thoracotomy. The primary outcome was in-hospital mortality.
Fifty-two patients were identified, 22 of whom underwent compressions only and 30 of whom went on to undergo thoracotomy. Patients who underwent compressions only were more likely to be female (36% vs 10%, P = .04), older (mean 46 vs 35 years, P = .04), and to experience blunt trauma (78% vs 43%, P = .01). Injury severity score was similar between the cohorts (mean 18 vs 28, P = .11). One patient in the compressions only cohort had a REBOA placed compared to two in the thoracotomy cohort (1.9% vs 3.67%, P > .99). Return of spontaneous circulation (ROSC) was achieved in 17% of the compressions only cohort compared to 45% of the thoracotomy cohort (P = .03). In-hospital mortality in the compressions only cohort was 100%, whereas in-hospital mortality in the thoracotomy cohort was 94% (P = .50), with a mean of zero survival days in both groups (P = .33).
Prehospital chest compressions without thoracotomy were uniformly fatal, even if transient ROSC was obtained. Our findings support termination of chest compressions for those trauma patients who do not meet criteria for resuscitative thoracotomy.
尽管对于需要进行复苏性开胸手术的创伤患者的适应症和预后已有充分研究，但对于不符合后续复苏性开胸手术标准的患者，院前胸部按压如何支持其生存却知之甚少。
收集了2015年1月至2020年12月期间在单一机构对需要院前胸部按压的创伤患者进行回顾性研究的数据。仅接受按压的患者与随后接受复苏性开胸手术的患者进行了比较。主要结局是院内死亡率。
共确定了52例患者，其中22例仅接受了按压，30例随后接受了开胸手术。仅接受按压的患者更可能为女性（36%对10%，P = 0.04）、年龄更大（平均46岁对35岁，P = 0.04），且更易遭受钝性创伤（78%对43%，P = 0.01）。两组的损伤严重程度评分相似（平均18对28，P = 0.11）。仅接受按压的队列中有1例患者放置了可重复充气式球囊阻断术（REBOA），而开胸手术队列中有2例（1.9%对3.67%，P > 0.99）。仅接受按压的队列中有17%实现了自主循环恢复（ROSC），而开胸手术队列中为45%（P = 0.03）。仅接受按压的队列院内死亡率为100%，而开胸手术队列院内死亡率为94%（P = 0.50），两组的平均生存天数均为零（P = 0.33）。
即使获得了短暂的ROSC，未进行开胸手术的院前胸部按压也均为致命性的。我们的研究结果支持对那些不符合复苏性开胸手术标准的创伤患者终止胸部按压。
