Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged: A Summary of Current Civilian EMS Practices and New Military Changes
Prehospital Mortality Due to Hemorrhagic Shock Remains High and Unchanged: A Summary of Current Civilian EMS Practices and New Military Changes
复制标题
DOI：
10.1097/shk.0000000000001522
复制
发表时间：
2021-12-01
期刊：
影响因子：
3.1
通讯作者：
Tatum, Danielle
中科院分区：
文献类型：
--
作者：
Duchesne, Juan;Taghavi, Sharven;Tatum, Danielle
继发于创伤相关失血性休克的死亡率几十年来没有改善。进展停滞的背后是有效的院前干预出血控制的难题。正如我们所知，在过去的20年里，无论是用力踩油门还是“留下来玩”都没有改变死亡率。因此，在处理将改善严重出血死亡率结局的有效变化时，需要创建混合型院前模式。基于普通平民院前程序（如现场插管和立即晶体液液体复苏）的证据，严重出血患者死亡率结局的改善充其量是微弱的。然而，止血带的使用，曾经被认为太危险而不能使用，在很大程度上是由于在军队中使用止血带的成功。它们在民用环境中的使用显示出有希望的结果。最近更新的军事高级复苏护理指南建议使用院前全血输血以及现场使用1区复苏性主动脉腔内球囊闭塞术。来自欧洲的几个案例研究表明，这些策略在平民中是可行的，但它们能在美国实施吗？
Mortality secondary to trauma-related hemorrhagic shock has not improved for several decades. Underlying the stall in progress is the conundrum of effective prehospital interventions for hemorrhage control. As we know, neither pressing hard on the gas nor "stay and play" has changed mortality over the last 20 years. For this reason, when dealing with effective changes that will improve severe hemorrhage mortality outcomes, there is a need for the creation of a hybrid prehospital model. Improvements in mortality outcomes for patients with severe hemorrhage based on evidence for common civilian prehospital procedures such as in-field intubation and immediate fluid resuscitation with crystalloid solution are weak at best. The use of tourniquets, once considered too risky to use, however, has risen dramatically in large part due to success seen during their use in the military. Their use in the civilian setting shows promising results. Recently updated military Advanced Resuscitative Care guidelines propose the use of prehospital whole blood transfusion as well as in-field use of Zone 1 Resuscitative Endovascular Balloon Occlusion of the Aorta. Several case studies from Europe suggest these strategies are feasible for use in the civilian population, but could they be implemented in the US?