分析作战环境中的紧急胸廓切开术。

IF 1.4 4区 医学 Q2 MEDICINE, GENERAL & INTERNAL Bmj Military Health Pub Date : 2024-08-29 DOI:10.1136/military-2024-002797
Andrew David Fisher, M D April, J M Gurney, S A Shackelford, C Luppens, S G Schauer
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引用次数: 0

摘要

简介:紧急胸廓切开术(ERT)是一种资源密集型手术,会耗尽战斗外科团队的供给,并转移对伤势更易存活的伤员的注意力。了解战斗创伤患者 ERT 后的存活率将为手术决策提供依据:方法:我们要求国防部创伤登记处 (DoDTR) 提供 2007 年至 2023 年期间的所有病例。我们分析了急诊科任何有记录的开胸手术,并排除了任何无法区分急诊科开胸手术和手术室开胸手术的病例。主要结果是 24 小时死亡率:原始数据集中有 48 301 名伤员。其中 154 人(0.3%)接受了 ERT,24 小时内 114 人未存活,40 人存活。30 天后有 26 人(17%)存活。其中大部分是在角色 3 中进行的。在非幸存者和幸存者中,美国军人所占比例最大。两组中均以爆炸物为主(61% 和 65%)。非幸存者的中位综合伤害严重程度评分较低(19 对 33)。非幸存者中头部重伤(13% 对 40%)和胸部重伤(32% 对 58%)的比例较低。非幸存者的红细胞消耗量中位数较低(10 单位对 19 单位),血浆(6 对 16)和血小板(0 对 3)的消耗量也较低。最常见的干预措施和外科手术是探查性开胸术(140 人)、胸廓造口术(137 人)、开放式心脏按摩(131 人)和闭合式心脏按摩(121 人):结论:对这组作战伤员进行 ERT 可使 26% 的伤员在 24 小时内存活。尽管这一比例高于民用数据,但仍需进行更严格的前瞻性研究,或改进 DoDTR 数据采集方法,以确定 ERT 在作战人群中的实用性。
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Analysis of emergency resuscitative thoracotomy in the combat setting.

Introduction: Emergency resuscitative thoracotomy (ERT) is a resource-intensive procedure that can deplete a combat surgical team's supply and divert attention from casualties with more survivable injuries. An understanding of survival after ERT in the combat trauma population will inform surgical decision-making.

Methods: We requested all encounters from 2007 to 2023 from the Department of Defense Trauma Registry (DoDTR). We analysed any documented thoracotomy in the emergency department and excluded any case for which it was not possible to distinguish ERT from operating room thoracotomy. The primary outcome was 24-hour mortality.

Results: There were 48 301 casualties within the original dataset. Of those, 154 (0.3%) received ERT, with 114 non-survivors and 40 survivors at 24 hours. There were 26 (17%) survivors at 30 days. The majority were performed in role 3. The US military made up the largest proportion among the non-survivors and survivors. Explosives predominated in both groups (61% and 65%). Median Composite Injury Severity Scores were lower among the non-survivors (19 vs 33). Non-survivors had a lower proportion of serious head injuries (13% vs 40%) and thorax injuries (32% vs 58%). Median RBC consumption was lower among non-survivors (10 units vs 19 units), as was plasma (6 vs 16) and platelets (0 vs 3). The most frequent interventions and surgical procedures were exploratory thoracotomy (n=140), chest thoracostomy (n=137), open cardiac massage (n=131) and closed cardiac massage (n=121).

Conclusion: ERT in this group of combat casualties resulted in 26% survival at 24 hours. Although this proportion is higher than that reported in civilian data, more rigorous prospective studies would need to be conducted or improvement in the DoDTR data capture methods would need to be implemented to determine the utility of ERT in combat populations.

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来源期刊
Bmj Military Health
Bmj Military Health MEDICINE, GENERAL & INTERNAL-
CiteScore
3.10
自引率
20.00%
发文量
116
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