Liu Shan, Ling Lin, Fu Yong, Zhang Wen-Chao, Zhang Yong-Hu, Li Qing, Zeng Liang, Hu Jun, Luo Yong, Liu Wen-Jie
Department of Emergency, The Second Affiliated Hospital, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China.
The Second Affiliated Hospital, National Regional Key Cities and Sub-central Cities in Hunan Province Hengyang Academician and Expert International Academic Exchange High Tech University, Building A First-class Discipline for Trauma and Critical Care, Hengyang Medical School, University of South China, Hengyang, 421001, Hunan province, China.
Chin J Traumatol. 2025 Jul;28(4):288-293. doi: 10.1016/j.cjtee.2024.07.009. Epub 2024 Jul 27.
Emergency resuscitative thoracotomy (ERT) is a final salvage procedure for critically injured trauma patients. Given its low success rate and ambiguous indications, its use in blunt trauma scenarios remains highly debated. Consequently, our study seeks to ascertain the overall survival rate of ERT in blunt trauma patients and determine which patients would benefit most from this procedure.
A retrospective case-control study was conducted for this research. Blunt trauma patients who underwent ERT between January 2020 and December 2023 in our trauma center were selected for analysis, with the endpoint outcome being in-hospital survival, divided into survival and non-survival groups. Inter-group comparisons were conducted using Chi-square and Fisher's exact tests, the Kruskal-Wallis test, Student's t-test, or the Mann-Whitney U test. Univariate and multivariate logistic regression analyses were conducted to assess potential predictors of survival. Then, the efficacy of the predictors was assessed through sensitivity and specificity analysis.
A total of 33 patients were included in the study, with 4 survivors (12.12%). Multivariate logistic regression analysis indicated a significant association between cardiac tamponade and survival, with an adjusted odds ratio of 33.4 (95% CI: 1.31 - 850.00, p = 0.034). Additionally, an analysis of sensitivity and specificity, targeting cardiac tamponade as an indicator for survivor identification, showed a sensitivity rate of 75.0% and a specificity rate of 96.6%.
The survival rate among blunt trauma patients undergoing ERT exceeds traditional expectations, suggesting that select individuals with blunt trauma can significantly benefit from the procedure. Notably, those presenting with cardiac tamponade are identified as the subgroup most likely to derive substantial benefits from ERT.
急诊复苏性开胸手术（ERT）是重症创伤患者的最后挽救措施。鉴于其成功率低且适应证不明确，其在钝性创伤情况下的应用仍存在高度争议。因此，我们的研究旨在确定ERT在钝性创伤患者中的总体生存率，并确定哪些患者将从该手术中获益最大。
本研究进行了一项回顾性病例对照研究。选取2020年1月至2023年12月在我们创伤中心接受ERT的钝性创伤患者进行分析，终点结局为住院生存情况，分为生存组和非生存组。组间比较采用卡方检验、费舍尔精确检验、Kruskal-Wallis检验、学生t检验或Mann-Whitney U检验。进行单因素和多因素逻辑回归分析以评估生存的潜在预测因素。然后，通过敏感性和特异性分析评估预测因素的有效性。
本研究共纳入33例患者，其中4例存活（12.12%）。多因素逻辑回归分析表明，心包填塞与生存之间存在显著关联，调整后的优势比为33.4（95%CI：1.31 - 850.00，p = 0.034）。此外，以心包填塞作为识别幸存者的指标进行敏感性和特异性分析，结果显示敏感性率为75.0%，特异性率为96.6%。
接受ERT的钝性创伤患者的生存率超过传统预期，表明部分钝性创伤患者可从该手术中显著获益。值得注意的是，出现心包填塞的患者被确定为最有可能从ERT中获得实质性益处的亚组。
