Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors

Abstract

AbstrActbackground Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning. results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24%) and 95 patients (14%) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95% CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95% CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95% CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95% CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95% CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95% CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95% CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital. conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.

Older age is associated with a reduced likelihood of ambulance transport to a trauma centre after major trauma in Perth

“…In keeping with the definition of trauma being ‘a body wound produced by sudden physical injury from impact, violence or accident’ we excluded trauma resulting from drowning, hanging or poisoning. This definition is also consistent with previous trauma studies . Patients not transported (i.e.…”

“…This definition is also consistent with previous trauma studies. 15,16 Patients not transported (i.e. from the scene of the incident) by SJA-WA and patients not transported by road ambulance were excluded from the study.…”

Epidemiology of trauma patients attended by ambulance paramedics in Perth, Western Australia

“…In the case of multiple emergency vehicle attendance to the same patient for the same incident, we included the data from the primary attending ambulance. Similar to studies conducted elsewhere, cases involving drowning, hanging or poisoning were excluded, which is consistent with the definition of physical trauma ‘as a body wound produced by sudden physical injury from impact, violence or accident’ . Cases that were missing key demographic and clinical data on the electronic patient care record (ePCR) were excluded.…”

Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: a nationwide observational study

“…12 However, the rate was comparable to that of sustained ROSC in patients with TOHCA in other studies and ranged from 19.6% to 31.4%. [13][14][15] These findings suggest that the resuscitation attempts in TOHCA patients without prehospital ROSC may be beneficial. However, the outcomes of TOHCA could be influenced by several factors, including the interval between the collapse and ED arrival, place of cardiac arrest, cardiac rhythm, and mechanism of trauma.…”