蘇生的開胸術の適応

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蘇生的開胸術の適応

1. 3分で読める蘇生的開胸術の適応 研修医・専攻医向け　まとめ

2. まとめ ①疑問 蘇生的開胸術に適応基準はあるのか？ ②回答 外傷専門診療ガイドライン JETECでは海外の推奨を元に適応基準を紹介 当スライドではEAST，WTAの適応を紹介

3. EAST Guideline 生命徴候の有無 穿通性外傷 or 鈍的外傷 胸部外傷 or 非胸部外傷 上記場合に分けて推奨を提案している A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73. 生命徴候の定義：対光反射、自発呼吸、頸動脈触知、触知または測定可能な血圧、四肢の動き、心臓の電気的活動　いずれかを認めること

4. EAST Guideline In patients presenting pulseless to the emergency department with signs of life after penetrating thoracic injury, we strongly recommend that patients undergo EDT. This recommendation is based on moderate quality of evidence and places emphasis on patient preference for improved survival and neurologically intact survival after EDT. ①生命徴候のある脈を触知しない穿通性胸部外傷 強く推奨 A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

5. EAST Guideline In patients presenting pulseless to the emergency department without signs of life after penetrating thoracic injury, we conditionally recommend that patients undergo EDT. This recommendation is based on moderate quality of evidence and places emphasis on patient preference for improved survival and neurologically intact survival after EDT but also acknowledges that elapsed time without signs of life is an important component. ②生命徴候のない脈を触知しない穿通性胸部外傷 条件付きで推奨※生命徴候のない時間による A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

6. EAST Guideline In patients presenting pulseless to the emergency department with signs of life after penetrating extrathoracic injury, we conditionally recommend that patients undergo EDT. This recommendation does not pertain to patients with isolated cranial injuries. This recommendation is based on moderate quality of evidence and places emphasis on patient preference for improved survival and neurologically intact survival after EDT but also acknowledges that penetrating injuries to all extrathoracic anatomic areas will not have equivalent salvage rates after EDT. ③生命徴候のある脈を触知しない穿通性非胸部外傷 条件付きで推奨※腹部、頸部、四肢などで有効である可能性　※単独頭部外傷は含まない A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

7. EAST Guideline In patients presenting pulseless to the emergency department without signs of life after penetrating extrathoracic injury, we conditionally recommend that patients undergo EDT. This recommendation does not pertain to patients with isolated cranial injuries and is based on low quality of evidence. The majority of subcommittee members believed that most patients would prefer undergoing EDT in hopes of improved survival and neurologically intact survival. ④生命徴候のない脈を触知しない穿通性非胸部外傷 条件付きで推奨※単独頭部外傷は含まない　※解析での対象症例が少なかった A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

8. EAST Guideline In patients presenting pulseless to the emergency department with signs of life after blunt injury, we conditionally recommend that patients undergo EDT. This recommendation is based on moderate quality of evidence and places emphasis on patient preference for improved survival and neurologically intact survival after EDT. ⑤生命徴候のある脈を触知しない鈍的外傷 条件付きで推奨※神経学的予後不良を問題点としてあげられた A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

9. EAST Guideline In patients presenting pulseless to the emergency department without signs of life after blunt injury, we conditionally recommend against the performance of EDT. This recommendation is based on low quality of evidence and reflects subcommittee group disagreement regarding the strength of the unanimous recommendation against EDT. ⑥生命徴候のない脈を触知しない鈍的外傷 条件付きで非推奨 A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

10. EAST Guideline ①生命徴候のある×穿通性胸部外傷　　強く推奨 ②生命徴候のない×穿通性胸部外傷　　条件付きで推奨 ③生命徴候のある×穿通性非胸部外傷　条件付きで推奨 ④生命徴候のない×穿通性非胸部外傷　条件付きで推奨 ⑤生命徴候のある×鈍的外傷　　　　　条件付きで推奨 ⑥生命徴候のない×鈍的外傷　　　　　条件付きで非推奨 A practice management guideline from the Eastern Association for the Surgery of Trauma An evidence-based approach to patient selection for emergency department thoracotomy A practice management guideline from the Eastern Association for the Surgery of Trauma J Trauma Acute Care Surg. 2015 Jul;79(1):159-73.

11. WTA 2012 ALGORITHMS 公式サイトで蘇生的開胸術のアルゴリズムを公開 生命徴候の有無、CPR継続時間、ショック状態を アルゴリズムの項目として組み込んでいる Western Trauma Association Critical Decisions in Trauma Resuscitative thoracotomy Western Trauma Association Critical Decisions in Trauma Resuscitative thoracotomy J Trauma Acute Care Surg. 2012 Dec;73(6):1359-63. . 2012 Dec;73(6):1359-63.

12. まとめ ①疑問 蘇生的開胸術の適応基準はあるのか？ ②回答 外傷専門診療ガイドライン JETECでは海外の推奨を元に適応基準を紹介 当スライドではEAST，WTAの適応を紹介