Transport Time and Preoperating Room Hemostatic Interventions Are Important: Improving Outcomes After Severe Truncal Injury

被引:96
作者
Holcomb, John B. [1 ]
机构
[1] UT Hlth, Dept Surg, Ctr Translat Injury Res, McGovern Med Sch, Houston, TX 77030 USA
关键词
injury; prehospital time; truncal hemorrhage control; COMBAT CASUALTY CARE; ENDOVASCULAR BALLOON OCCLUSION; MAJOR LIMB TRAUMA; GOLDEN HOUR; HEMORRHAGIC-SHOCK; AORTA REBOA; TRANSFUSION; MULTICENTER; MORTALITY; RESUSCITATION;
D O I
10.1097/CCM.0000000000002915
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Objectives: Experience in the ongoing wars in Iraq and Afghanistan confirm that faster transport combined with effective prehospital interventions improves the outcomes of patients suffering hemorrhagic shock. Outcomes of patients with hemorrhagic shock and extremity bleeding have improved with widespread use of tourniquets and early balanced transfusion therapy. Conversely, civilian patients suffering truncal bleeding and shock have the same mortality (46%) over the last 20 years. To understand how to decrease this substantial mortality, one must first critically evaluate all phases of care from point of injury to definitive hemorrhage control in the operating room. Data Sources: Limited literature review. Data Synthesis: The peak time to death after severe truncal injury is within 30 minutes of injury. However, when adding prehospital transport time, time spent in the emergency department, followed by the time in the operating room, it currently takes 2.1 hours to achieve definitive truncal hemorrhage control. This disparity in uncontrolled truncal bleeding and time to hemorrhage control needs to be reconciled. Prehospital and emergency department whole blood transfusion and temporary truncal hemorrhage control are now possible. Conclusions: The importance of rapid transport, early truncal hemorrhage control and whole blood transfusion is now widely recognized. Prehospital temporary truncal hemorrhage control and whole blood transfusion should offer the best possibility of improving patient outcomes after severe truncal injury.
引用
收藏
页码:447 / 453
页数:7
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