Abstract：
The desire to deliver appropriate care after trauma creates challenges when deciding to proceed if care appears futile. This study aimed to analyze survival rates for trauma patients who undergo closed chest compressions by decade of life.
A multicenter retrospective review of trauma patients with an Injury Severity Score ≥16 who underwent closed chest compressions from 2015 to 2020 at four large, urban, academic Level I trauma centers was conducted. Those with intraoperative arrest were excluded. The primary endpoint was survival to discharge.
Of the 247 patients meeting inclusion criteria, 18% were 70 years or older, 78% were male, and 24% presented due to a penetrating mechanism of injury. Compressions occurred in the prehospital setting (56%), emergency department (21%), intensive care unit (19%), and on the floor (3%). On average, patients arrested on hospital day 2, and survived 1 day after arrest if return of spontaneous circulation was achieved. Overall mortality was 92%. Average hospital length of stay was lower in patients 70 years or older (3 days vs. 6 days, p < 0.01). Survival was highest in patients 60 years to 69 years (24%), and although patients 70 years or older presented with lower Injury Severity Scores (28 vs. 32, p = 0.04), no patient 70 years or older survived to hospital discharge (0% v 9%, p = 0.03).
Closed chest compressions are associated with a high mortality rate after moderate to severe trauma with 100% mortality in patients older than 70 years. This information may assist with the decision to withhold chest compression, especially in older adults.
Prognostic and Epidemiological; Level IV.
A multicenter retrospective review of trauma patients with an Injury Severity Score ≥16 who underwent closed chest compressions from 2015 to 2020 at four large, urban, academic Level I trauma centers was conducted. Those with intraoperative arrest were excluded. The primary endpoint was survival to discharge.
Of the 247 patients meeting inclusion criteria, 18% were 70 years or older, 78% were male, and 24% presented due to a penetrating mechanism of injury. Compressions occurred in the prehospital setting (56%), emergency department (21%), intensive care unit (19%), and on the floor (3%). On average, patients arrested on hospital day 2, and survived 1 day after arrest if return of spontaneous circulation was achieved. Overall mortality was 92%. Average hospital length of stay was lower in patients 70 years or older (3 days vs. 6 days, p < 0.01). Survival was highest in patients 60 years to 69 years (24%), and although patients 70 years or older presented with lower Injury Severity Scores (28 vs. 32, p = 0.04), no patient 70 years or older survived to hospital discharge (0% v 9%, p = 0.03).
Closed chest compressions are associated with a high mortality rate after moderate to severe trauma with 100% mortality in patients older than 70 years. This information may assist with the decision to withhold chest compression, especially in older adults.
Prognostic and Epidemiological; Level IV.
摘要：
背景：创伤后提供适当护理的愿望在决定是否治疗徒劳时提出了挑战。这项研究旨在分析十年来接受闭式胸部按压的创伤患者的生存率。
方法：对2015年至2020年受伤严重程度评分≥16的创伤患者进行了四个大的闭式胸部按压，城市,进行了学术一级创伤中心。术中停止者被排除在外。主要终点是生存至出院。
结果：在247名符合纳入标准的患者中，18%是70岁或以上，78%是男性，24%是由于穿透损伤机制而出现的。压缩发生在院前设置（56％），急诊科（21%），重症监护病房（19%），在地板上（3％）。平均而言,在医院第2天被捕的患者，如果实现了自发循环的恢复，则在被捕后存活1天。总死亡率为92%。70岁或以上患者的平均住院时间较低(3天vs.6天,p<0.01)。生存率最高的患者为60年至69年（24％），尽管70岁或以上的患者受伤严重程度评分较低(28与32，p=0.04），没有70岁或70岁以上的患者存活到出院(0%v9%，p=0.03)。
结论：在70岁以上的患者中，闭合胸部按压与中度至重度创伤后的高死亡率相关，死亡率为100%。这些信息可能有助于决定停止胸部按压，尤其是老年人。
方法：预后和流行病学；IV级。
方法：对2015年至2020年受伤严重程度评分≥16的创伤患者进行了四个大的闭式胸部按压，城市,进行了学术一级创伤中心。术中停止者被排除在外。主要终点是生存至出院。
结果：在247名符合纳入标准的患者中，18%是70岁或以上，78%是男性，24%是由于穿透损伤机制而出现的。压缩发生在院前设置（56％），急诊科（21%），重症监护病房（19%），在地板上（3％）。平均而言,在医院第2天被捕的患者，如果实现了自发循环的恢复，则在被捕后存活1天。总死亡率为92%。70岁或以上患者的平均住院时间较低(3天vs.6天,p<0.01)。生存率最高的患者为60年至69年（24％），尽管70岁或以上的患者受伤严重程度评分较低(28与32，p=0.04），没有70岁或70岁以上的患者存活到出院(0%v9%，p=0.03)。
结论：在70岁以上的患者中，闭合胸部按压与中度至重度创伤后的高死亡率相关，死亡率为100%。这些信息可能有助于决定停止胸部按压，尤其是老年人。
方法：预后和流行病学；IV级。
