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

Autor: de Malleray, Hilaire, de Lesquen, Henri, Boddaert, Guillaume, Raux, Mathieu, Lefrançois, Valentin, Delhaye, Nathalie, Ponsin, Pauline, Cordorniu, Anaïs, Floch, Thierry, Bounes, Fanny, Gaertner, Elisabeth, Hardy, Alexia, Bordes, Julien, Meaudre, Éric, Cardinale, Michael
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Zdroj: Journal of Visceral Surgery; Dec2024, Vol. 161 Issue 6, p356-363, 8p
Abstrakt: • Emergency resuscitative thoracotomy is a procedure rarely performed in French trauma centers. • However, it is a procedure that can reduce mortality and should be included in protocols for the management of severe trauma. • It is particularly effective in cases of patients with penetrating trauma arriving with signs of life. 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. 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. 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 64 mins [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 6 h. 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. 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. [ABSTRACT FROM AUTHOR]
Databáze: Supplemental Index
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