Prehospital care for traumatic cardiac arrest in the US: A cross-sectional analysis and call for a national guideline,Resuscitation

当前位置： X-MOL 学术 › Resuscitation › 论文详情

Our official English website, www.x-mol.net, welcomes your feedback! (Note: you will need to create a separate account there.)

Prehospital care for traumatic cardiac arrest in the US: A cross-sectional analysis and call for a national guideline
Resuscitation ( IF 6.5 ) Pub Date : 2022-08-12 , DOI: 10.1016/j.resuscitation.2022.08.005
Alexander J Ordoobadi ₁ , Gregory A Peters ₂ , Sean MacAllister ₃ , Geoffrey A Anderson ₁ , Ashish R Panchal ₄ , Rebecca E Cash ₅

Affiliation

Aim

We describe emergency medical services (EMS) protocols and prehospital practice patterns related to traumatic cardiac arrest (TCA) management in the U.S.

Methods

We examined EMS management of TCA by 1) assessing variability in recommended treatments in state EMS protocols for TCA and 2) analyzing EMS care using a nationwide sample of EMS activations. We included EMS activations involving TCA in adult (≥18 years) patients where resuscitation was attempted by EMS. Descriptive statistics for recommended and actual treatments were calculated and compared between blunt and penetrating trauma using χ² and independent 2-group Mann-Whitney U tests.

Results

There were 35 state EMS protocols publicly available for review, of which 16 (45.7%) had a specific TCA protocol and 17 (48.5%) had a specific termination of resuscitation protocol for TCA. Recommended treatments varied. We then analyzed 9,565 EMS activations involving TCA (79.1% blunt, 20.9% penetrating). Most activations (93%) were managed by advanced life support. Return of spontaneous circulation was achieved in 25.5% of activations, and resuscitation was terminated by EMS in 26.4% of activations. Median prehospital scene time was 16.4 minutes; scene time was shorter for penetrating mechanisms than blunt (12.0 vs 17.0 min, p < 0.001). Endotracheal intubation was performed in 32.0% of activations, vascular access obtained in 66.6%, crystalloid fluids administered in 28.8%, and adrenaline administered in 60.1%.

Conclusion

Actual and recommended approaches to EMS treatment of TCA vary nationally. These variations in protocols and treatments highlight the need for a standardized approach to prehospital management of TCA in the U.S.

中文翻译：

美国创伤性心脏骤停的院前护理：横断面分析并呼吁制定国家指南

目标

我们描述了与美国创伤性心脏骤停 (TCA) 管理相关的紧急医疗服务 (EMS) 协议和院前实践模式

方法

我们通过以下方式检查了 TCA 的 EMS 管理：1）评估 TCA 州 EMS 协议中推荐治疗的变异性；2）使用全国范围的 EMS 激活样本分析 EMS 护理。我们纳入了涉及 TCA 的成人（≥18 岁）患者的 EMS 激活，这些患者尝试通过 EMS 进行复苏。^使用χ2和独立的 2 组 Mann-Whitney U 检验计算并比较钝性和穿透性创伤的推荐和实际治疗的描述性统计数据。

结果

有 35 个州 EMS 方案公开可供审查，其中 16 个 (45.7%) 具有特定的 TCA 方案，17 个 (48.5%) 具有针对 TCA 的特定终止复苏方案。推荐的治疗方法多种多样。然后，我们分析了涉及 TCA 的 9,565 次 EMS 激活（79.1% 钝，20.9% 穿透）。大多数激活 (93%) 由高级生命支持管理。在 25.5% 的激活中实现了自主循环的恢复，在 26.4% 的激活中通过 EMS 终止了复苏。院前现场时间中位数为 16.4 分钟；穿透机制的场景时间比钝器短（12.0 对 17.0 分钟，p < 0.001)。32.0% 的患者进行了气管插管，66.6% 的患者进行了血管通路，28.8% 的患者使用了晶体液，60.1% 的患者使用了肾上腺素。