Damage-control resuscitation and emergency laparotomy: Findings from the PROPPR study.
Damage-control resuscitation and emergency laparotomy: Findings from the PROPPR study.
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DOI：
10.1097/ta.0000000000000960
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
PROPPR Study Group
中科院分区：
文献类型：
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作者：
Undurraga Perl VJ;Leroux B;Cook MR;Watson J;Fair K;Martin DT;Kerby JD;Williams C;Inaba K;Wade CE;Cotton BA;Del Junco DJ;Fox EE;Scalea TM;Tilley BC;Holcomb JB;Schreiber MA;PROPPR Study Group
Pragmatic Randomized Optimal Platelet and Plasma Ratios（PROPPR）试验表明，损伤控制复苏是一种大规模输血策略，目标是以1：1：1的比例平衡输送血浆-血小板-RBC，与1：1：2的比例相比，3小时存活率提高，前24小时因失血导致的死亡减少。根据这些发现，我们假设接受1：1：1比例的患者在急诊剖腹手术后的生存率会有所提高。根据PROPPR试验中的描述，预计将在12个I级北美创伤中心接受大量输血的严重损伤患者被随机分配至1：1：1与1：1：2。从这些患者中，确定了接受紧急剖腹手术的亚组，该亚组先前在文献中定义为到达后90分钟内进行剖腹手术。我们比较了急诊剖腹手术的发生率和时间，以及术后24小时和30天的生存率。在680例入组患者中，613例接受了外科手术，397例接受了剖腹手术，346例接受了紧急剖腹手术。1：1：1和1：1：2组接受紧急剖腹手术的患者百分比分别为51.5%（174/338）和50.3%（172/342）（p=0.20）。两个治疗组中至剖腹手术的中位时间均为28分钟。在接受紧急剖腹手术的患者中，两个治疗组存活至24小时和30天的患者比例相似，1：1：1组的24小时存活率为86.8%（151/174），1：1：2组为83.1%（143/172）（p=0.29），1：1：1组为79.3%（138/174），1：1：2组为75.0%（129/172）（p=0.30）。我们没有发现任何证据表明复苏策略会影响患者是否需要紧急剖腹手术，剖腹手术的时间或随后的生存率。IV级，治疗性研究。
The Pragmatic Randomized Optimal Platelet and Plasma Ratios (PROPPR) trial has demonstrated that damage control resuscitation, a massive transfusion strategy targeting a balanced delivery of plasma-platelet-RBC in a ratio of 1:1:1, results in improved survival at 3 hours and a reduction in deaths due to exsanguination in the first 24 hours compared to a 1:1:2 ratio. In light of these findings, we hypothesized that patients receiving 1:1:1 ratio would have improved survival after emergency laparotomy. Severely injured patients predicted to receive a massive transfusion admitted to 12 level I North American trauma centers were randomized to 1:1:1 versus 1:1:2 as described in the PROPPR trial. From these patients, the subset that underwent an emergency laparotomy, defined previously in the literature as laparotomy within 90 minutes of arrival, were identified. We compared rates and timing of emergency laparotomy as well as post-surgical survival at 24-hours and 30-days. Of the 680 enrolled patients, 613 underwent a surgical procedure, 397 underwent a laparotomy, and 346 underwent an emergency laparotomy. The percentages of patients undergoing emergency laparotomy were 51.5% (174/338) and 50.3% (172/342) for 1:1:1 and 1:1:2, respectively (p=0.20). Median time to laparotomy was 28 minutes in both treatment groups. Among patients undergoing an emergency laparotomy, the proportions of patients surviving to 24 hours and 30 days were similar between treatment arms, 24-hour survival was 86.8% (151/174) for 1:1:1 and 83.1% (143/172) for 1:1:2 (p=0.29), and 30-day 79.3% (138/174) for 1:1:1 and 75.0% (129/172) for 1:1:2 (p=0.30). We found no evidence that resuscitation strategy affects whether a patient requires an emergency laparotomy, time to laparotomy, or subsequent survival. Level IV, therapeutic study.