juries. 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学遭遇、护理实践和结果：9 年单中心美国 1 级创伤经历


陪审 团。我们的目标是检查急性枪伤患者与非枪伤相比的麻醉护理、资源利用和结局。方法： 我们对 2014 年至 2022 年间在地区 1 级创伤中心收治的 ≥18 岁患者进行了一项回顾性横断面研究，这些患者需要在到达医院后的前 2 小时内进行手术管理。我们检查了枪伤患者与非枪伤患者相比的临床特征、麻醉学护理实践以及术中和术后结局。结果： 在 9 年的研究期间，枪支伤害占创伤入院人数的最大年平均增幅 （枪支 10.1%，钝器 3.2%，其他 1.3%，机动车碰撞 0.9%）。4.7% 的受伤患者 （2124;541 枪支 [25.4%] 和 1583 [74.5%] 非枪支）在到达后 2 小时内接受了紧急麻醉护理。枪伤患者更年轻（30 [23-40] 岁 vs 41 [29-56] 岁;P < .0001），男性 （90% 对 75%;P < .0001），现场直接入院（78% 对 62%;P < .0001），多发性创伤较少 （10% 对 22%;P < .0001），下班后到达 （73% 对 63%;P < .0001），并接受早期麻醉护理 （到达后 0.4 [0.3-0.7] 对 0.9 [0.5-1.5] 小时;P < .0001）.枪支损伤患者更常接受侵入性动脉治疗 （83% vs 77%;P < .0001） 和中心静脉 （14% 对 10%;P = .02） 插管、血液制品 （3 [0-11] 对 0 [0-7] 单位;P < .0001），氨甲环酸 （30% 对 22%;P < .001），并且估计失血量较高（500 [200–1588] mL vs 300 [100–1000] mL;P < .0001），并且更频繁地转移到重症监护病房 （ICU） （83% 对 77%;P < .001） 比非枪伤患者。 术中死亡率相当（6% 枪支 vs 4% 非枪支），但术中幸存下来的枪支损伤患者的术后死亡率较低 （6% vs 14%;P < .0001）.相比之下，更多的枪伤患者被送回家或入狱 （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之外出现，需要紧急手术干预。手术室准备和高强度复苏能力，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局至关重要，特别是对于枪支受伤的患者。