Maruyama Shuhei, Wada Daiki, Yoshihara Tomoyuki, Saito Fukuki, Yoshiya Kazuhisa, Nakamori Yasushi, Kuwagata Yasuyuki
Department of Emergency and Critical Care Medicine Kansai Medical University Medical Center Osaka Japan.
Department of Emergency and Critical Care Medicine Kansai Medical University Hospital Osaka Japan.
Acute Med Surg. 2024 Jan 29;11(1):e928. doi: 10.1002/ams2.928. eCollection 2024 Jan-Dec.
Computed tomography (CT) is useful in trauma care. Severely ill trauma patients may not tolerate whole-body CT even without patient transfer. This study examined clinical flow of severe trauma patients requiring aortic occlusion (AO) such as resuscitative thoracotomy or REBOA in the hybrid emergency room (ER) and investigated patient clinical courses prioritizing CT first versus resuscitation including AO first.
This retrospective, single-center observational study included consecutive trauma patients visiting our ER between May 2016 and February 2023. Patients were divided into the CT first group (whole-body CT preceded AO) and AO first group (AO preceded whole-body CT) and into two subgroups: AO after CT (AO/interventions for hemorrhage performed just after CT in the CT first group), and CT after AO (CT or damage control surgery performed after AO in the AO first group). We investigated 28-day survival rates.
Survival probability by TRISS method was 49% (range: 3.3-94) in the CT first group ( = 6) and 20% (range: 0.7-45) in the AO first group ( = 7). Actual 28-day survival rates were 50% and 57%, respectively. Survival rates of the AO after CT subgroup (CT first group) were 75% (3/4) and 0% (0/2), respectively, and those of the CT after AO subgroup (AO first group) were 25% (1/4) and 100% (3/3), respectively.
In severe trauma patients with low predicted probability of survival treated in the hybrid ER, survival rates might be better if resuscitation including AO is performed before CT and if damage control surgery is performed first before CT.
计算机断层扫描（CT）在创伤治疗中很有用。即使不进行患者转运，重症创伤患者也可能无法耐受全身CT检查。本研究检查了在混合急诊室（ER）中需要进行主动脉阻断（AO）（如复苏性开胸手术或可重复使用球囊主动脉内阻断术）的严重创伤患者的临床流程，并研究了优先进行CT检查与优先进行包括AO在内的复苏的患者临床病程。
这项回顾性单中心观察性研究纳入了2016年5月至2023年2月期间连续就诊于我们急诊室的创伤患者。患者被分为CT优先组（全身CT检查先于AO）和AO优先组（AO先于全身CT检查），并进一步分为两个亚组：CT后AO组（CT优先组中在CT检查后立即进行AO/出血干预）和AO后CT组（AO优先组中在AO后进行CT检查或损伤控制手术）。我们调查了28天生存率。
CT优先组（n = 6）采用创伤和损伤严重度评分（TRISS）方法得出的生存概率为49%（范围：3.3 - 94），AO优先组（n = 7）为20%（范围：0.7 - 45）。实际28天生存率分别为50%和57%。CT后AO亚组（CT优先组）的生存率分别为75%（3/4）和0%（0/2），AO后CT亚组（AO优先组）的生存率分别为25%（1/4）和100%（3/3）。
在混合急诊室接受治疗的生存预测概率较低的严重创伤患者中，如果在CT检查前进行包括AO在内的复苏，并且在CT检查前先进行损伤控制手术，生存率可能会更高。
