Nardi G, Massarutti D, Muzzi R, Kette F, De Monte A, Carnelos G A, Peressutti R, Berlot G, Giordano F, Gullo A
Department of Anaesthesia, Regional Hospital of Udine, Italy.
Eur J Emerg Med. 1994 Jun;1(2):69-77.
The hypothesis that high level on-the-field ATLS could influence mortality in severe trauma patients was tested by means of a prospective study. During a 7 month period, data of all the victims of severe involuntary trauma (road traffic accidents, work and sport accidents) in 3 Provinces of north-east Italy were entered in a database and analysed. The whole area is covered by a single emergency service which has direct control over all the ambulances and the Emergency Helicopter Service (EMHS). The area concerned by the study has a surface of 7,300 kmq with a population of 1 million inhabitants and is served by 12 first level hospitals and 4 second level institutions (trauma centres). All the patients who were still alive at the time of arrival of the first rescuers were considered, but only severe trauma patients with ISS > 15 were enclosed into the study. All the patients were followed up to their discharge from the ICUs (end point). There were three different rescue approaches: 82 Patients (GROUP A) were rescued by EMTs with BLS training, transported to the nearest level 1 hospital for stabilisation and subsequently transferred to a trauma center; 98 Patients (GROUP B) were rescued by EMTs and directly transported to a trauma centre which was the nearest institution; 42 Patients were rescued on the scene by the EMHS team including an anaesthesiologist with 10 years experience in trauma care and directly transported to a trauma centre after full on-the-field stabilisation (GROUP C) RESULTS: 222 severe trauma patients (ISS > 15) were considered. Mean ISS was 35.1 +/- 18.2 in group A, 33.4 +/- 19.6 in group B and 36.0 +/- 17.8 in group C. 67 patients died previous to ICU discharge (31%). 31 over the 82 pts in Group A (38%) died. 23 of them died even before reaching the trauma centre. The mean time elapsed between the first emergency call and the arrival at the trauma centre was 162 min (90'-300'). Mean ICU stay for patients who survived was 15 days. In Group B 31 over 98 patients (32%) died before ICU discharge. The mean time between the emergency call and hospital admission was 27'. Mean ICU stay for patients who were discharged, was 13 days. 5 over 42 patients rescued by the EMHS (Group C) died, none of them in the pre-hospital setting. Stabilisation included tracheal intubation in 34 cases (81%) and thoracic drainage in 6 (14%). All the patients arrived at the hospital with 2 i.v. line. The average amount of infused fluids were 600 mls of colloids and 810 mls of crystalloid. 13 patients with hypotension received and average of 1000 mls of colloids and 1200 mls of crystalloid. The average time elapsed between the emergency call and the final admission to the definitive care institution was 55'. Mean ICU stay was 11 days. Mortality rate in this group was 12%, significantly lower than in group A (p < 0.005) and group B (p < 0.05).
通过一项前瞻性研究对高水平现场高级创伤生命支持（ATLS）能否影响严重创伤患者死亡率这一假设进行了验证。在7个月的时间里，意大利东北部3个省份所有严重非自愿创伤（道路交通事故、工作和运动事故）受害者的数据被录入数据库并进行分析。整个地区由单一的急救服务机构覆盖，该机构对所有救护车和紧急直升机服务（EMHS）有直接控制权。研究涉及的区域面积为7300平方公里，人口100万，由12家一级医院和4家二级机构（创伤中心）提供服务。所有在首批救援人员到达时仍存活的患者都被纳入考虑，但只有损伤严重度评分（ISS）>15的严重创伤患者被纳入研究。所有患者均随访至其从重症监护病房（ICU）出院（终点）。有三种不同的救援方式：82例患者（A组）由接受过基础生命支持（BLS）培训的急救医疗技术员（EMT）进行救援，转运至最近的一级医院进行稳定治疗，随后转至创伤中心；98例患者（B组）由EMT进行救援并直接转运至最近的创伤中心；42例患者由EMHS团队在现场进行救援，该团队包括一名在创伤护理方面有10年经验的麻醉医生，在现场进行全面稳定治疗后直接转运至创伤中心（C组）。结果：共纳入222例严重创伤患者（ISS>15）。A组的平均ISS为35.1±18.2，B组为33.4±19.6，C组为36.0±17.8。67例患者在ICU出院前死亡（31%）。A组82例患者中有31例（38%）死亡。其中23例甚至在到达创伤中心之前就死亡了。首次紧急呼叫至到达创伤中心的平均时间为162分钟（90 - 300分钟）。存活患者的平均ICU住院时间为15天。B组98例患者中有31例（32%）在ICU出院前死亡。紧急呼叫至入院的平均时间为27分钟。出院患者的平均ICU住院时间为13天。EMHS救援的42例患者（C组）中有5例死亡，其中无一例在院前死亡。稳定治疗包括34例（81%）气管插管和6例（14%）胸腔引流。所有患者入院时均有两条静脉通路。输注液体的平均量为600毫升胶体液和810毫升晶体液。13例低血压患者平均接受了1000毫升胶体液和
