French practice of emergency resuscitative thoracotomy. A study based on the Traumabase Registry.

IF 2 4区医学 Q2 SURGERY

Journal of Visceral Surgery Pub Date : 2024-08-02 DOI:10.1016/j.jviscsurg.2024.07.002

Hilaire de Malleray, Henri de Lesquen, Guillaume Boddaert, Mathieu Raux, Valentin Lefrançois, Nathalie Delhaye, Pauline Ponsin, Anaïs Cordorniu, Thierry Floch, Fanny Bounes, Elisabeth Gaertner, Alexia Hardy, Julien Bordes, Éric Meaudre, Michael Cardinale

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引用次数: 0

Abstract

Aim of the study: Emergency resuscitative thoracotomy (ERT) has been described as a potentially life-saving procedure for trauma patients who have been admitted in refractory shock or with recent loss of sign of life (SOL). This nationwide registry analysis aimed to describe the French practice of ERT.

Patients and methods: From 2015 to 2021, all severe trauma patients who underwent ERT were extracted from the TraumaBase→ registry. Demographic data, prehospital management and in-hospital outcomes were recorded to evaluate predictors of success-to rescue after ERT at 24-hour and 28-day.

Results: Only 10/26 Trauma centers have an effective practice of ERT, three of them perform more than 1 ERT/year. Sixty-six patients (74% male, 49/66) with a median age of 37 y/o [26-51], mostly with blunt trauma (52%, 35/66) were managed with ERT. The median pre-hospital time was 64mins [45-89]. At admission, the median injury severity score was 35 [25-48], and 51% (16/30) of patients have lost SOL. ERT was associated with a massive transfusion protocol including 8 RBCs [6-13], 6 FFPs [4-10], and 0 PCs [0-1] in the first 6h. The overall success-to-rescue after ERT at 24-h and 28-d were 27% and 15%, respectively. In case of refractory shock after penetrating trauma, survival was 64% at 24-hours and 47% at 28-days.

Conclusions: ERT integrated into the trauma protocol remains a life-saving procedure that appears to be underutilized in France, despite significant success-to-rescue observed by trained teams for selected patients.

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法国急诊胸廓切开术的实践。基于创伤数据库登记的研究。

研究目的：紧急胸廓切开复苏术（ERT）被认为是一种可能挽救生命的手术，适用于因难治性休克或近期失去生命迹象（SOL）而入院的创伤患者。这项全国范围的登记分析旨在描述法国的 ERT 实践：从 2015 年到 2021 年，所有接受 ERT 的严重创伤患者均来自 TraumaBase→ 登记处。记录人口统计学数据、院前管理和院内结果，以评估ERT后24小时和28天抢救成功的预测因素：结果：只有 10/26 个创伤中心有效实施了 ERT，其中 3 个中心每年实施 ERT 超过 1 次。66 名患者（74% 为男性，49/66）接受了 ERT 治疗，中位年龄为 37 岁/o [26-51]，大部分为钝性创伤患者（52%，35/66）。入院前的中位时间为 64 分钟 [45-89]。入院时，受伤严重程度的中位数为 35 [25-48]，51%（16/30）的患者失去了 SOL。ERT 与大量输血方案有关，包括在最初 6 小时内输注 8 个红细胞 [6-13]、6 个全血细胞 [4-10] 和 0 个 PCs [0-1]。ERT 后 24 小时和 28 天的总抢救成功率分别为 27% 和 15%。对于穿透性创伤后的难治性休克患者，24 小时内的存活率为 64%，28 天内的存活率为 47%：将 ERT 纳入创伤救治方案仍是一种挽救生命的方法，但在法国似乎未得到充分利用，尽管训练有素的团队对选定患者的抢救成功率很高。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Visceral Surgery SURGERY-

CiteScore

2.00

自引率

9.50%

发文量

108

审稿时长

>12 weeks

期刊介绍： The Journal of Visceral Surgery (JVS) is the online-only, English version of the French Journal de Chirurgie Viscérale. The journal focuses on clinical research and continuing education, and publishes original and review articles related to general surgery, as well as press reviews of recently published major international works. High-quality illustrations of surgical techniques, images and videos serve as support for clinical evaluation and practice optimization. JVS is indexed in the main international databases (including Medline) and is accessible worldwide through ScienceDirect and ClinicalKey.