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.
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。