背景:针式胸廓造口术(NT)是一种常见的院前干预措施,适用于因创伤而出现极值或心脏骤停的患者。这项研究的目的是比较结果,功效,在集水区超过160万人的四县紧急医疗服务(EMS)系统中,与NT相关的政策发生变化后,并发症。
方法:这是在美国中部加利福尼亚(美国)EMS系统中进行的所有NT患者的观察性研究之前和之后。之前,前锁骨中线(MCL)组包括2007年5月7日至2013年2月28日接受NT的所有患者。之后,腋下中线(MAL)腋组包括从2013年3月1日至2016年1月30日接受NT的所有患者,在政策修订更改时间后,针头尺寸,和NT的放置位置。所有进行NT的院前和医院记录都被查询人口统计学,损伤机制,初始状态和NT后临床变化,报告的并发症,和最终结果。访问创伤登记处以获得损伤严重程度评分(ISS)。信息由研究研究者手动提取,并利用单变量和多变量分析进行检查。
结果:这项研究纳入了三百零五名接受NT治疗的创伤患者,其中,169例患者(MCL组)在第二肋间间隙(ICS)用至少5.0厘米长的14号静脉内(IV)导管治疗,被放置在救护车中后的MCL;和136名患者(MAL组)在第五次ICS中接受了至少9.5cm长的10号静脉导管治疗,MAL在现场。MAL队列中的平均ISS较低(64.5对69.2;P=.007)。两组的死亡率均为79%。关于生存的多变量模型支持较低的ISS(P<.001)和NT后报告的临床变化(P=.003)是生存的显著指标。未报告NT并发症。
结论:更改时间,针的长度,放置位置并没有改变需要NT的患者的死亡率。在政策改变后,针胸造口术的使用频率更高,MAL队列受伤较少。报告的并发症没有增加。Weichthalla,欧文,StrohG,拉莫斯.针胸造口术:改变针的长度和位置会改变患者的预后吗?灾难医学杂志。2018;33(3):237-244。
BACKGROUND: Needle thoracostomy (NT) is a common prehospital intervention for patients in extremis or cardiac arrest due to trauma. The purpose of this study is to compare outcomes, efficacy, and complications after a change in policy related to NT in a four-county Emergency Medical Services (EMS) system with a catchment area of greater than 1.6 million people.
METHODS: This is a before and after observational study of all patients who had NT performed in the Central California (USA) EMS system. The before, anterior midclavicular line (MCL) group consisted of all patients who underwent NT from May 7, 2007 through February 28, 2013. The after, midaxillary line (MAL) axillary group consisted of all patients who underwent NT from March 1, 2013 through January 30, 2016, after policy revisions changed the timing, needle size, and placement location for NT. All prehospital and hospital records where NT was performed were queried for demographics, mechanism of injury, initial status and post-NT clinical change, reported complications, and final outcome. The trauma registry was accessed to obtain Injury Severity Scores (ISS). Information was manually abstracted by study investigators and examined utilizing univariate and multivariate analyses.
RESULTS: Three-hundred and five trauma patients treated with NT were included in this study, of which, 169 patients (the MCL group) were treated with a 14-guage intravenous (IV) catheter at least 5.0-cm long at the second intercostal space (ICS), MCL after being placed in the ambulance; and 136 patients (the MAL group) were treated with a 10-guage IV catheter at least 9.5-cm long at the fifth ICS, MAL on scene. The mean ISS was lower in the MAL cohort (64.5 versus 69.2; P=.007). The mortality rate was 79% in both groups. The multivariate model with regard to survival supported that a lower ISS (P<.001) and reported clinical change after NT (P=.003) were significant indicators of survival. No complications from NT were reported.
CONCLUSIONS: Changing the timing, length of needle, and location of placement did not change mortality in patients requiring NT. Needle thoracostomy was used more frequently after the change in policy, and the MAL cohort was less injured. No increase in reported complications was noted. WeichenthalLA, OwenS, StrohG, RamosJ. Needle thoracostomy: does changing needle length and location change patient outcome? Prehosp Disaster Med. 2018;33(3):237-244.