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每一分钟都很重要:通过医院前高级复苏护理改善穿透创伤的结果

Juan Duchesne¹, Bryant J McLafferty, Jacob M Broome

¹From the Department of Surgery (J.D., B.J.M., S.C., J.P.R., D.T., S.T., O.J.-W., S.T., P.M., K.N.H.), Tulane University School of Medicine, division of Trauma Department of surgery, New Orleans, Lousiana; Medstar Georgetown Washington Hospital Center (J.M.B.), Washington, DC; Lousiana State University Health Science Center New Orleans (A.S.); New Orleans Emergency Medical Services (E.N., T.D., M.M.), New Orleans, Lousiana; and WakeMed Health and Hospitals (M.P.), Raleigh, NC.

The journal of trauma and acute care surgery

|May 1, 2024

概括

在创伤患者早期的医院前血液 (PHB) 管理显著降低了医院内死亡率. 输血延迟每分钟会增加11%的死亡风险,这凸显了接近受伤点的快速复苏的重要性.

科学领域:

紧急医疗紧急医疗
创伤外科手术创伤外科
关键的护理关键的护理

背景情况:

对于创伤性出血,使用血液制品进行医院前复苏越来越多地被采用.
在MEDEVAC试验中,早期服用血液制品对生存有好处.
与城市EMS中第一次输血时间相关的死亡率数据有限,有穿透创伤.

研究的目的:

为了研究在紧急医疗服务 (EMS) 与严重出血患者接触后15分钟内给予血液制品的生存益处.
为了比较接受医院前血液和历史对照的患者之间的住院死亡率.

主要方法:

在城市的EMS系统中,对预期的医院前血液 (PHB) 管理数据库 (2021-2023) 的回顾性分析.
与PHB实施 (2016-2019) 之前的创伤登记控制相比.
纳入标准:穿透伤害,SBP ≤ 90 mm Hg;排除:孤立的头部创伤,医院前的心脏骤停. 主要变量:输血时间和住院死亡率.

主要成果:

分析了143名患者 (61名PHB,82名对照);没有人口统计学差异.
PHB队列的场景和运输时间更长 (5分钟的增加).
在PHB组中,到达第一个血液单元的时间显著较短 (8分钟比27分钟;p <0.01). 住院死亡率较低 (7%与29%相比;p < 0.01).
多变量回归显示,每分钟延迟输血时,死亡率独立增加11% (OR1.11,95%CI1.04-1.19).

结论:

早期PHB给药 (19分钟前) 改善了与医院抵达后输血相比的生存率,尽管增加了医院前的时间.
死亡率上升11%与每分钟的延迟输血有关.
PHB干预可以通过更接近受伤点开始治疗来提高创伤复苏结果.

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