Out-of-hospital cardiac arrest due to cervical spine injury by uncertain trauma; A study of two cases

Abstract

Cervical spinal cord injury is a well-known cause of cardiac arrest in trauma victims. Unless trauma is definitively suspected, emergency medical services teams perform resuscitation in the pre-hospital stage without cervical spine immobilization. During advanced cardiovascular life support (ACLS), intubation with cervical spinal immobilization causes difficulty in accessing the airway, thus, immobilization tends to not be performed, unless the patient is a clear case of trauma. We report two patients with out-of-hospital cardiac arrests (OHCA) due to cervical fractures that have occurred without clear trauma. In these cases, pre-existing cervical spine lesions was additional informed and identification of the cervical spine fractures was delayed. Emergency medical physicians tend to neglect cervical spine injury when the likelihood of trauma is unclear in a patient presenting with OHCA. These cases urge physicians to consider the possibility of cervical spinal injuries, even in cases of minor trauma. If there is a possibility of cervical spinal injury, imaging should not be delayed and should be followed by appropriate treatment.

Association between Cerebrospinal Fluid and Serum Biomarker Levels and Diagnosis, Injury Severity, and Short-Term Outcomes in Patients with Acute Traumatic Spinal Cord Injury

“…Most of the patients with SCI suffer from a severe sensory deficit and neuropathic pain and experience multisystem dysfunctions, including the urinary, gastrointestinal, and pulmonary systems and autonomic dysfunction [6]. In aged patients, minor trauma caused by falls and other accidents can sometimes result in SCI [7]. In a study that evaluated injury-related mortality and disability in six European countries, SCI was found to be the second leading cause of morbidity and disability after traumatic brain injury (TBI) [8].…”

“…On the other hand, missing the medical diagnosis of SCI can have dramatic consequences, as can the medico-legal implications associated with them [12]. It is important to note that established clinical evaluations that are commonly used may not apply to all patients exposed to traffic accidents, and may be difficult to use in patients with undefined traumas [7]. For example, in the absence of radiological findings using computed tomography of the spine, a diagnosis of SCI may be easily overlooked [12].…”