背景:严重烧伤患者的院前管理极具挑战性。它应该包括足够的镇痛,院前气管插管和晶体液管理的必要性决策。准则建议在满足某些标准时立即运输到专业烧伤中心。迄今为止,对院前急救特点的认识还不够。我们试图调查当前的实践及其对患者预后的潜在影响。
方法:我们进行了一个中心,严重烧伤患者的回顾性队列分析(总烧伤表面积>20%),2014年至2019年期间进入柏林烧伤中心。从急诊医疗服务报告和数字患者图表中提取相关数据,以进行探索性数据分析。主要结果是28天死亡率。
结果:90名患者(男/女60/30,中位年龄52岁[四分位距,IQR37-63],包括中位烧伤面积36%[IQR25-51]和中位体重指数26.56kg/m2[IQR22.86-30.86].从创伤到ED到达的中位时间为1小时45分钟;在这段时间内,平均1961毫升晶体液(0.48毫升/千克/%TBSA,施用IQR0.32-0.86)。大多数患者接受基于阿片类药物的镇痛。插管的患者从创伤到ED到达的时间更长。过度的液体治疗(>1000ml/h)或>2h的运输时间均与较高的死亡率无关。共有31名患者(34,4%)在住院期间死亡。多因素回归分析显示,非生存与年龄>65岁相关(比值比(OR)3.5,95%CI:1.27-9.66),吸入性损伤(OR3.57,95%CI:1.36-9.36),烧伤面积>60%(OR5.14,95%CI1.57-16.84)和院前插管(5.38,95%CI:1.92-15.92)。
结论:我们显示严重烧伤患者在住院前经常接受过量补液,这与更多的血流动力学稳定性或结局无关。在我们的队列中,患者经常在院前插管,这与死亡率增加有关。进一步的研究和急诊医务人员的培训应集中在适当的液体应用上,并对院前插管的风险和收益进行谨慎的决策。
背景:德国临床试验注册中心(ID:DRKS00033516)。
BACKGROUND: Prehospital management of severely burned patients is extremely challenging. It should include adequate analgesia, decision-making on the necessity of prehospital endotracheal intubation and the administration of crystalloid fluids. Guidelines recommend immediate transport to specialised burn centres when certain criteria are met. To date, there is still insufficient knowledge on the characteristics of prehospital emergency treatment. We sought to investigate the current practice and its potential effects on patient outcome.
METHODS: We conducted a single centre, retrospective cohort analysis of severely burned patients (total burned surface area > 20%), admitted to the Berlin burn centre between 2014 and 2019. The relevant data was extracted from Emergency Medical Service reports and digital patient charts for exploratory data analysis. Primary outcome was 28-day-mortality.
RESULTS: Ninety patients (male/female 60/30, with a median age of 52 years [interquartile range, IQR 37-63], median total burned surface area 36% [IQR 25-51] and median body mass index 26.56 kg/m2 [IQR 22.86-30.86] were included. The median time from trauma to ED arrival was 1 h 45 min; within this time, on average 1961 ml of crystalloid fluid (0.48 ml/kg/%TBSA, IQR 0.32-0.86) was administered. Most patients received opioid-based analgesia. Times from trauma to ED arrival were longer for patients who were intubated. Neither excessive fluid treatment (> 1000 ml/h) nor transport times > 2 h was associated with higher mortality. A total of 31 patients (34,4%) died within the hospital stay. Multivariate regression analysis revealed that non-survival was linked to age > 65 years (odds ratio (OR) 3.5, 95% CI: 1.27-9.66), inhalation injury (OR 3.57, 95% CI: 1.36-9.36), burned surface area > 60% (OR 5.14, 95% CI 1.57-16.84) and prehospital intubation (5.38, 95% CI: 1.92-15.92).
CONCLUSIONS: We showed that severely burned patients frequently received excessive fluid administration prehospitally and that this was not associated with more hemodynamic stability or outcome. In our cohort, patients were frequently intubated prehospitally, which was associated with increased mortality rates. Further research and emergency medical staff training should focus on adequate fluid application and cautious decision-making on the risks and benefits of prehospital intubation.
BACKGROUND: German Clinical Trial Registry (ID: DRKS00033516).