BACKGROUND Firearm injuries cause significant morbidity and mortality. Patients with firearm injuries require urgent/emergency operative procedures but the literature incompletely describes how anesthesia care and outcomes differ between high acuity trauma patients with and without firearm injuries. Our objective was to examine anesthesia care, resource utilization, and outcomes of patients with acute firearm injuries compared to nonfirearm injuries. METHODS We conducted a retrospective cross-sectional study of patients ≥18 years admitted to a regional Level 1 trauma center between 2014 and 2022 who required operative management within the first 2 hours of hospital arrival. We examined clinical characteristics, anesthesiology care practices, and intra- and postoperative outcomes of patients with firearm injuries compared to patients with nonfirearm injuries. RESULTS Over the 9-year study period, firearm injuries accounted for the largest yearly average increase in trauma admissions (firearm 10.1%, blunt 3.2%, other 1.3%, motor-vehicle crash 0.9%). Emergency anesthesiology care within 2 hours of arrival was delivered to 4.7% of injured patients (2124; 541 firearm [25.4%] and 1583 [74.5%] nonfirearm). Patients with firearm injuries were younger (30 [23-40] years vs 41 [29-56] years; P < .0001), male (90% vs 75%; P < .0001), direct admissions from scene (78% vs 62%; P < .0001), had less polytrauma (10% vs 22%; P < .0001), arrived after hours (73% vs 63%; P < .0001), and received earlier anesthesiology care (0.4 [0.3-0.7] vs 0.9 [0.5-1.5] hours after arrival; P < .0001). Patients with firearm injuries more often received invasive arterial (83% vs 77%; P < .0001) and central venous (14% vs 10%; P = .02) cannulation, blood products (3 [0-11] vs 0 [0-7] units; P < .0001), tranexamic acid (30% vs 22%; P < .001), as well as had higher estimated blood loss (500 [200-1588] mL vs 300 [100-1000] mL; P < .0001), and were transferred to the intensive care unit (ICU) more frequently (83% vs 77%; P < .001) than patients with nonfirearm injuries. Intraoperative mortality was comparable (6% firearm vs 4% nonfirearm) but postoperative mortality was lower for patients with firearm injuries who survived the intraoperative course (6% vs 14%; P < .0001). Comparatively, more patients with firearm injuries were discharged to home, or to jail (P < .001). CONCLUSIONS Over the study period, anesthesiologists increasingly cared for patients with firearm injuries, who often present outside of daytime hours and require urgent operative intervention. Operating room readiness and high-intensity resuscitation capacity, such as access to hemostatic control measures, are critical to achieving intraoperative survival and favorable postoperative outcomes, particularly for patients with firearm injuries.

中文翻译：

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枪伤患者的紧急麻醉遭遇、护理实践和结果：美国 9 年单中心 1 级创伤经验。


背景技术枪伤导致显着的发病率和死亡率。枪伤患者需要紧急/紧急手术程序，但文献不完全描述有和没有枪伤的高危创伤患者之间麻醉护理和结果的差异。我们的目的是检查急性枪伤患者与非枪伤患者的麻醉护理、资源利用和结果。方法 我们对 2014 年至 2022 年间入住地区 1 级创伤中心的年龄≥18 岁且在到达医院后 2 小时内需要手术治疗的患者进行了一项回顾性横断面研究。我们比较了枪伤患者与非枪伤患者的临床特征、麻醉护理实践以及术中和术后结果。结果 在 9 年的研究期间，枪伤占外伤入院人数年平均增幅最大（枪伤 10.1%，钝器伤 3.2%，其他伤 1.3%，机动车碰撞伤 0.9%）。 4.7% 的受伤患者在抵达后 2 小时内获得了紧急麻醉护理（2124 名；541 名持枪患者 [25.4%] 和 1583 名非枪支患者 [74.5%]）。枪伤患者较年轻（30 [23-40] 岁 vs 41 [29-56] 岁；P < .0001），男性（90% vs 75%；P < .0001），直接从现场入院（78%相对 62%；P < .0001），多发伤较少（10% 相对 22%；P < .0001），下班后到达（73% 相对 63%；P < .0001），并接受较早的麻醉护理（0.4 [ 0.3-0.7] vs 到达后 0.9 [0.5-1.5] 小时；P < .0001)。枪伤患者更常接受侵入性动脉（83% vs 77%；P < .0001）和中心静脉（14% vs 10%；P = .02）插管、血液制品（3 [0-11] vs 0 [ 0-7] 单位；0001）、氨甲环酸（30% vs 22%；P < .001），以及估计失血量较高（500 [200-1588] mL vs 300 [100-1000] mL；P < .0001），以及与非枪伤患者相比，被转移到重症监护病房 (ICU) 的频率更高（83% vs 77%；P < .001）。术中死亡率相当（6% 枪伤 vs 4% 非枪伤），但术中幸存的枪伤患者术后死亡率较低（6% vs 14%；P < .0001）。相比之下，更多的枪伤患者出院回家或入狱 (P < .001)。结论 在研究期间，麻醉师越来越多地照顾枪伤患者，这些患者经常在白天以外的时间就诊，需要紧急手术干预。手术室准备就绪和高强度复苏能力（例如获得止血控制措施）对于实现术中生存和良好的术后结果至关重要，特别是对于枪伤患者。