AAST 多中心前瞻性分析院前止血带在四肢创伤中的应用。
AAST multicenter prospective analysis of prehospital tourniquet use for extremity trauma.
机构信息
From the Department of Surgery (R.S., A.S., K.A., J.D.), Tulane University School of Medicine, New Orleans, Louisiana; University of Colorado Health Memorial (T.J.S., Z.E.S.), Colorado Springs, Colorado; Inova Trauma Center (E.J.T., E.L.), Inova Fairfax Hospital, Annandale; Department of Surgery (P.F., J.H.), Virginia Commonwealth University, Richmond, Virginia; Department of Surgery (R.D.F.), Cooper University Health Care, Camden, New Jersey; Acute Care Surgery Division (A.G.M., D.R.F.), University of Nevada, Las Vegas, Las Vegas, Nevada; Department of Surgery (M.S.T., H.M.G.V.), Methodist Dallas Medical Center, Dallas, Texas; Department of Surgery (S.R.T.), Baylor College of Medicine, Houston, Texas; Department of Surgery (D.Tu., A.P.), Loma Linda University Medical Center, Loma Linda; Department of Surgery (L.N.G., T.W.C.), University of California San Diego; Department of Surgery (D.K., K.I.), Los Angeles County, University of Southern California Medical Center, Los Angeles, California; Department of Surgery (J.B., A.W.), West Virginia University, Morgantown, West Virginia; Department of Surgery (J.G.M.), University of Texas Health Science Center at San Antonio, San Antonio, Texas; Department of Trauma Services (J.M.H., K.L.L.), Ascension Via Christi Saint Francis, Wichita, Kansas; Department of Surgery (H.O.B., A.J.B.), University of Kentucky, Lexington, Kentucky; Department of Trauma and Acute Care (W.D., L.Z.), Medical Center of the Rockies, Loveland, Colorado; Department of Surgery (G.C., M.Lin.), Mount Sinai Hospital, New York, New York; Department of Surgery (B.M., D.Ta.), Our Lady of the Lake Regional Medical Center, Baton Rouge, Louisiana; Department of Surgery (P.E.F.), The University of Tennessee Health Science Center; Elvis Presley Trauma Center (M.Lie.), Regional One Health, Memphis, Tennessee; Research Medical Center (R.C.M.), EmCare Surgical Services, Kansas City, Missouri; Department of Trauma Research and Education (L.L.), St. Mary's Medical Center, West Palm Beach, Florida; Department of Surgery (C.G.V., S.U.), University of Colorado Hospital, Aurora, Colorado; Trauma Department (M.D., A.B.), North Oaks Medical Center, Hammond, Louisiana; Department of Surgery (M.P., A.G.), University of Arkansas Medical Center, Little Rock, Arkansas; Department of Surgery (T.M.E.), University of Utah, Salt Lake City, Utah; Department of Surgery (P.T.), University of Texas at Austin, Austin, Texas; Department of Surgery (D.Y.K., G.S.), Harbor-UCLA Medical Center, West Carson, California; Department of Surgery (P.E., C.H.), Wright State University, Dayton, Ohio; and Department of Surgery (R.A., B.O.), Brigham and Women's Hospital, Boston, Massachusetts.
出版信息
J Trauma Acute Care Surg. 2022 Jun 1;92(6):997-1004. doi: 10.1097/TA.0000000000003555. Epub 2022 Jan 18.
BACKGROUND
Tourniquet use for extremity hemorrhage control has seen a recent increase in civilian usage. Previous retrospective studies demonstrated that tourniquets improve outcomes for major extremity trauma (MET). No prospective study has been conducted to date. The objective of this study was to evaluate outcomes in MET patients with prehospital tourniquet use. We hypothesized that prehospital tourniquet use in MET decreases the incidence of patients arriving to the trauma center in shock.
METHODS
Data were collected prospectively for adult patients with MET at 26 Level I and 3 Level II trauma centers from 2015 to 2020. Limbs with tourniquets applied in the prehospital setting were included in the tourniquet group and limbs without prehospital tourniquets were enrolled in the control group.
RESULTS
A total of 1,392 injured limbs were enrolled with 1,130 tourniquets, including 962 prehospital tourniquets. The control group consisted of 262 limbs without prehospital tourniquets and 88 with tourniquets placed upon hospital arrival. Prehospital improvised tourniquets were placed in 42 patients. Tourniquets effectively controlled bleeding in 87.7% of limbs. Tourniquet and control groups were similarly matched for demographics, Injury Severity Score, and prehospital vital signs (p > 0.05). Despite higher limb injury severity, patients in the tourniquet group were less likely to arrive in shock compared with the control group (13.0% vs. 17.4%, p = 0.04). The incidence of limb complications was not significantly higher in the tourniquet group (p > 0.05).
CONCLUSION
This study is the first prospective analysis of prehospital tourniquet use for civilian extremity trauma. Prehospital tourniquet application was associated with decreased incidence of arrival in shock without increasing limb complications. We found widespread tourniquet use, high effectiveness, and a low number of improvised tourniquets. This study provides further evidence that tourniquets are being widely and safely adopted to improve outcomes in civilians with MET.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
背景
在控制四肢出血方面，止血带的使用在民用领域的应用最近有所增加。先前的回顾性研究表明，止血带可改善严重四肢创伤（MET）的预后。迄今为止，尚未进行前瞻性研究。本研究旨在评估院前使用止血带治疗 MET 患者的结局。我们假设在 MET 患者中，院前使用止血带可降低休克患者到达创伤中心的发生率。
方法
从 2015 年至 2020 年，在 26 个一级和 3 个二级创伤中心前瞻性收集成人 MET 患者的数据。纳入在院前环境中使用止血带的肢体为止血带组，纳入未在院前使用止血带的肢体为对照组。
结果
共纳入 1392 个受伤肢体，其中 1130 个使用止血带，包括 962 个院前使用的止血带。对照组包括 262 个未在院前使用止血带和 88 个在入院时使用止血带的肢体。有 42 例患者使用了院前临时止血带。止血带有效控制了 87.7%的肢体出血。止血带组和对照组在人口统计学、损伤严重程度评分和院前生命体征方面相似（p＞0.05）。尽管肢体损伤严重程度较高，但与对照组相比，止血带组患者休克到达的可能性更小（13.0%比 17.4%，p=0.04）。止血带组肢体并发症的发生率并没有显著升高（p＞0.05）。
结论
这是首例针对民用四肢创伤的院前使用止血带的前瞻性分析。院前应用止血带与降低休克发生率相关，而不会增加肢体并发症。我们发现止血带的广泛使用、高有效性和低比例的临时止血带。本研究进一步证明，止血带在民用 MET 患者中被广泛且安全地采用，以改善预后。
证据水平
治疗/护理管理；IV 级。
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