城市急救医疗服务系统中更快的补液可挽救生命：院前高级复苏治疗包的前瞻性初步评估。
Faster refill in an urban emergency medical services system saves lives: A prospective preliminary evaluation of a prehospital advanced resuscitative care bundle.
机构信息
Department of Surgery, MedStar Georgetown Washington Hospital Center, (J.M.B.) Washington DC; Department of Surgery (K.D.N., D.T., S.C., C.B., S.T., O.J.-W., C.H., P.M., J.D.), Tulane University School of Medicine, New Orleans, Louisiana; Department of Pediatrics (M.P.), and Department of Emergency Medicine (V.J.D.M.), University of North Carolina at Chapel Hill, Chapel Hill; WakeMed Health and Hospitals (M.P.), Raleigh, North Carolina; Lousiana State University Health Science Center New Orleans (A.S.); New Orleans Emergency Medical Services (E.N., T.D., D.R., M.M.); and New Orleans Health Department, New Orleans, Louisiana (J.A.).
出版信息
J Trauma Acute Care Surg. 2024 May 1;96(5):702-707. doi: 10.1097/TA.0000000000004239. Epub 2024 Jan 8.
INTRODUCTION
Military experience has demonstrated mortality improvement when advanced resuscitative care (ARC) is provided for trauma patients with severe hemorrhage. The benefits of ARC for trauma in civilian emergency medical services (EMS) systems with short transport intervals are still unknown. We hypothesized that ARC implementation in an urban EMS system would reduce in-hospital mortality.
METHODS
This was a prospective analysis of ARC bundle administration between 2021 and 2023 in an urban EMS system with 70,000 annual responses. The ARC bundle consisted of calcium, tranexamic acid, and packed red blood cells via a rapid infuser. Advanced resuscitative care patients were compared with trauma registry controls from 2016 to 2019. Included were patients with a penetrating injury and systolic blood pressure ≤90 mm Hg. Excluded were isolated head trauma or prehospital cardiac arrest. In-hospital mortality was the primary outcome of interest.
RESULTS
A total of 210 patients (ARC, 61; controls, 149) met the criteria. The median age was 32 years, with no difference in demographics, initial systolic blood pressure or heart rate recorded by EMS, or New Injury Severity Score between groups. At hospital arrival, ARC patients had lower median heart rate and shock index than controls ( p ≤ 0.03). Fewer patients in the ARC group required prehospital advanced airway placement ( p < 0.001). Twenty-four-hour and total in-hospital mortality were lower in the ARC group ( p ≤ 0.04). Multivariable regression revealed an independent reduction in in-hospital mortality with ARC (odds ratio, 0.19; 95% confidence interval, 0.05-0.68; p = 0.01).
CONCLUSION
Early ARC in a fast-paced urban EMS system is achievable and may improve physiologic derangements while decreasing patient mortality. Advanced resuscitative care closer to the point of injury warrants consideration.
LEVEL OF EVIDENCE
Therapeutic/Care Management; Level IV.
简介
军事经验表明，为严重出血的创伤患者提供先进的复苏治疗（ARC）可提高生存率。在具有较短转运时间的民用紧急医疗服务（EMS）系统中，ARC 对创伤的益处尚不清楚。我们假设在城市 EMS 系统中实施 ARC 会降低院内死亡率。
方法
这是对城市 EMS 系统中 2021 年至 2023 年 ARC 套件管理的前瞻性分析，该系统每年有 70000 次响应。ARC 套件包括通过快速输液器给予钙、氨甲环酸和浓缩红细胞。将 ARC 患者与 2016 年至 2019 年创伤登记对照进行比较。纳入标准为穿透性损伤且收缩压≤90mmHg 的患者。排除标准为孤立性头部创伤或院前心脏骤停。院内死亡率是主要观察结果。
结果
共有 210 名患者（ARC 组 61 名，对照组 149 名）符合标准。中位年龄为 32 岁，两组在人口统计学、EMS 记录的初始收缩压或心率或新损伤严重程度评分方面无差异。到达医院时，ARC 患者的心率和休克指数中位数低于对照组（p≤0.03）。ARC 组需要院前高级气道放置的患者较少（p<0.001）。ARC 组 24 小时和总院内死亡率较低（p≤0.04）。多变量回归显示 ARC 与院内死亡率降低独立相关（优势比，0.19；95%置信区间，0.05-0.68；p=0.01）。
结论
在快节奏的城市 EMS 系统中尽早实施 ARC 是可行的，可能会改善生理紊乱，同时降低患者死亡率。在更接近受伤点的地方实施先进的复苏治疗值得考虑。
证据水平
治疗/护理管理；IV 级。
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