Department of Surgery, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States; Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States.
Harvard Medical School, 25 Shattuck Street, Boston, MA 02115, United States; Department of Emergency Medicine, Massachusetts General Hospital, 55 Fruit Street, Boston, MA 02114, United States; Department of Emergency Medicine, Brigham and Women's Hospital, 75 Francis Street, Boston, MA 02115, United States.
Resuscitation. 2022 Oct;179:97-104. doi: 10.1016/j.resuscitation.2022.08.005. Epub 2022 Aug 12.
We describe emergency medical services (EMS) protocols and prehospital practice patterns related to traumatic cardiac arrest (TCA) management in the U.S.
We examined EMS management of TCA by 1) assessing variability in recommended treatments in state EMS protocols for TCA and 2) analyzing EMS care using a nationwide sample of EMS activations. We included EMS activations involving TCA in adult (≥18 years) patients where resuscitation was attempted by EMS. Descriptive statistics for recommended and actual treatments were calculated and compared between blunt and penetrating trauma using χ and independent 2-group Mann-Whitney U tests.
There were 35 state EMS protocols publicly available for review, of which 16 (45.7%) had a specific TCA protocol and 17 (48.5%) had a specific termination of resuscitation protocol for TCA. Recommended treatments varied. We then analyzed 9,565 EMS activations involving TCA (79.1% blunt, 20.9% penetrating). Most activations (93%) were managed by advanced life support. Return of spontaneous circulation was achieved in 25.5% of activations, and resuscitation was terminated by EMS in 26.4% of activations. Median prehospital scene time was 16.4 minutes; scene time was shorter for penetrating mechanisms than blunt (12.0 vs 17.0 min, p < 0.001). Endotracheal intubation was performed in 32.0% of activations, vascular access obtained in 66.6%, crystalloid fluids administered in 28.8%, and adrenaline administered in 60.1%.
Actual and recommended approaches to EMS treatment of TCA vary nationally. These variations in protocols and treatments highlight the need for a standardized approach to prehospital management of TCA in the U.S.
我们描述了美国与创伤性心搏骤停（TCA）管理相关的紧急医疗服务（EMS）方案和院前实践模式。
我们通过以下两种方式来评估 TCA 的 EMS 管理：1）评估 TCA 州 EMS 方案中推荐治疗方法的差异，2）使用全国性 EMS 激活样本分析 EMS 护理。我们纳入了成年（≥18 岁）患者中 TCA 所致 EMS 尝试复苏的 EMS 激活病例。计算并比较了推荐和实际治疗的描述性统计数据，使用 χ2 和独立 2 组曼-惠特尼 U 检验比较钝器伤和穿透伤之间的差异。
共有 35 份州 EMS 方案可供审查，其中 16 份（45.7%）有特定的 TCA 方案，17 份（48.5%）有特定的 TCA 复苏终止方案。推荐的治疗方法存在差异。然后我们分析了 9565 例涉及 TCA 的 EMS 激活（79.1%钝器伤，20.9%穿透伤）。大多数激活（93%）由高级生命支持管理。25.5%的激活中出现自主循环恢复，26.4%的激活中 EMS 终止复苏。院前现场时间中位数为 16.4 分钟；穿透伤机制的现场时间短于钝器伤（12.0 与 17.0 min，p<0.001）。32.0%的激活中进行了气管插管，66.6%获得了血管通路，28.8%给予晶体液，60.1%给予肾上腺素。
美国 TCA 的 EMS 治疗实际和推荐方法存在差异。这些方案和治疗方法的差异突出表明，美国需要对 TCA 的院前管理采用标准化方法。
