Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury

2021 ◽  
pp. emermed-2021-211723
Author(s):  
Tan N Doan ◽  
Daniel Wilson ◽  
Stephen Rashford ◽  
Louise Sims ◽  
Emma Bosley
Keyword(s):  
Cardiac Arrest ◽  
Motor Vehicle ◽  
Burn Injury ◽  
Prehospital Care ◽  
Survival Rates ◽  
Traumatic Cardiac Arrest ◽  
Vehicle Collision ◽  
Advanced Airway ◽  
Injury Mechanisms ◽  
High Acuity

BackgroundSurvival from out-of-hospital traumatic cardiac arrest (TCA) is poor. Regional variation exists regarding epidemiology, management and outcomes. Data on prognostic factors are scant. A better understanding of injury patterns and outcome determinants is key to identifying opportunities for survival improvement.MethodsIncluded were adult (≥18 years) out-of-hospital TCA due to blunt, penetrating or burn injury, who were attended by Queensland Ambulance Service paramedics between 1 January 2007 and 31 December 2019. We compared the characteristics of patients who were pronounced dead on paramedic arrival and those receiving resuscitation from paramedics. Intra-arrest procedures were described for attempted-resuscitation patients. Survival up to 6 months postarrest was reported, and factors associated with survival were investigated.Results3891 patients were included; 2394 (61.5%) were pronounced dead on paramedic arrival and 1497 (38.5%) received resuscitation from paramedics. Most arrests (79.8%) resulted from blunt trauma. Motor vehicle collision (42.4%) and gunshot wound (17.7%) were the most common injury mechanisms in patients pronounced dead on paramedic arrival, whereas the most prevalent mechanisms in attempted-resuscitation patients were motor vehicle (31.3%) and motorcycle (20.6%) collisions. Among attempted-resuscitation patients, rates of transport and survival to hospital handover, to hospital discharge and to 6 months were 31.9%, 15.3%, 9.8% and 9.8%, respectively. Multivariable model showed that advanced airway management (adjusted OR 1.84; 95% CI 1.06 to 3.17), intravenous access (OR 5.04; 95% CI 2.43 to 10.45) and attendance of high acuity response unit (highly trained prehospital care clinicians) (OR 2.54; 95% CI 1.25 to 5.18) were associated with improved odds of survival to hospital handover.ConclusionsBy including all paramedic-attended patients, this study provides a more complete understanding of the epidemiology of out-of-hospital TCA. Contemporary survival rates from adult out-of-hospital TCA who receive resuscitation from paramedics may be higher than historically thought. Factors identified in this study as associated with survival may be useful to guide prognostication and treatment.

131 Characterizing atlanto-occipital dissociation and its association with pediatric traumatic cardiac arrest: A descriptive case series

2021 ◽  
Vol 26 (Supplement_1) ◽  
pp. e92-e93
Author(s):  
Dayae Jeong ◽  
Gabrielle Freire ◽  
Suzanne Beno
Keyword(s):  
Cardiac Arrest ◽  
Motor Vehicle ◽  
Prehospital Care ◽  
Pediatric Trauma ◽  
Case Series ◽  
Spine Injury ◽  
Trauma Patients ◽  
X Ray ◽  
Traumatic Cardiac Arrest ◽  
Mild Disability

Abstract Primary Subject area Emergency Medicine - Paediatric Background Atlanto-occipital dislocation (AOD) is a type of cervical spine injury (CSI) that is commonly fatal or associated with severe neurologic consequences. Although rare, AOD is now more commonly recognized in children as improved prehospital care allows for more patients to reach trauma centres and undergo definitive imaging. Patients with AOD often present with cardiorespiratory instability and prompt diagnosis is crucial. However, diagnosis may be delayed due to variation in imaging practices and lack of literature on this topic. Objectives Primary objective: Describe the demographic characteristics, clinical presentation, and long-term outcomes of children with AOD, compared to other upper CSI. Secondary objective: Describe the frequency of AOD and other upper CSI in pediatric traumatic cardiac arrest (PTCA) and the utility of a lateral c-spine radiograph in this setting. Design/Methods This was a retrospective, single-centre case series of all pediatric trauma patients age < 16 years diagnosed with upper CSI seen at a tertiary pediatric trauma centre from 2000-2020. Patients were included if they had evidence of bony or ligamentous injury from C0-2. The diagnosis of upper CSI was ascertained on autopsy, when available, then cross-sectional imaging, then plain radiographs, when the other modalities were unavailable. Data was obtained from manual chart review and analyzed using descriptive statistics. Results Thirty-six patients were excluded for not meeting upper CSI criteria. Of 93 patients with upper CSI, 24 had AOD: 14 (15%) complete and 10 (11%) incomplete (Table 1). The mechanism of injury was motor-vehicle-collision in 23 (96%) of these patients, and a fall in one (4%). All patients with complete AOD presented in PTCA and only one (7%) survived. Of seven patients with AOD who received a lateral c-spine x-ray during resuscitation, 5 (71%) had identifiable injuries. In contrast, of the 10 patients with incomplete AOD, only 1 (10%) presented in arrest and none died. Only one patient received an x-ray during resuscitation, which showed the injury but went undetected, and 100% of final diagnoses were made through CT. The majority of incomplete AOD patients were managed non-operatively and had minimal to mild disability. Conclusion In our study population, complete AOD was highly fatal with all patients presenting in PTCA. In contrast, incomplete AOD carried a more favorable prognosis with 100% survival and minimal-mild disability. If there is suspicion for AOD, a lateral c-spine XR in the trauma bay can aid in early diagnosis, guiding neurosurgical management and/or goals of care discussions.

Abstract 18070: Therapies Optimizing Organ Perfusion and Protection After Out-of-hospital Cardiac Arrest Improves Survival With Favorable Neurologic Outcome

Circulation ◽  
2015 ◽  
Vol 132 (suppl_3) ◽  
Author(s):  
Michael J Jacobs ◽  
Leo S Derevin ◽  
Sue Duval ◽  
James E Pointer ◽  
Karl A Sporer
Keyword(s):  
Cardiac Arrest ◽  
Survival Rates ◽  
Cerebral Performance Category ◽  
Spontaneous Circulation ◽  
Outcome Data ◽  
Neurological Function ◽  
Inverse Association ◽  
Advanced Airway ◽  
Initial Rhythm ◽  
Hospital Cardiac Arrest

Introduction: Survival rates with favorable neurologic function after out-of-hospital cardiac arrest (OHCA) have remained low for decades. Hypothesis: Use of therapies focused on better perfusion during CPR using mechanical adjuncts and protective post-resuscitation care would improve survival and neurologic outcomes after OHCA compared to conventional CPR and care. Methods: OHCA outcomes in Alameda County, CA, USA, population 1.5 million, from December 2009-2011 when there was incomplete availability and use of impedance threshold device [ITD], mechanical CPR [MCPR], and hospital therapeutic hypothermia [HTH], were compared to 2012 when all were available and more widely used. Return of Spontaneous Circulation (ROSC), survival and Cerebral Performance Category (CPC) scores were compared using univariate and multivariable analyses. Results: Of the 3008 non-traumatic OHCAs who received CPR during the study period, >95% of survival outcome data were available. From 2009-11 to 2012, there was an increase in ROSC from 28.6% to 34.1% (p=0.002; OR=1.28; CI=1.09, 1.51) and a non-significant increase in hospital discharge from 10.5% to 12.3% (p=0.14; OR=1.17; CI=0.92, 1.49). There was, however, an 80% increase in survival with favorable neurological function between the two periods, as determined by CPC≤2, from 4.4% to 7.9% (p<0.001; unadjusted OR=1.85; CI=1.35, 2.54). After adjusting for witnessed arrest, bystander CPR, initial rhythm (VT/VF vs. others), placement of an advanced airway, EMS response time, and age, the adjusted OR was 1.60 (1.11, 2.31; p=0.012). Using a stepwise regression model, the most important independent positive predictors of CPC≤2 were 2012 (p=0.019), witnessed (p<0.001), initial rhythm VT/VF (p<0.001), and advanced airway (inverse association p<0.001). Additional analyses of the three therapies, separately and in combination, demonstrated that for all patients admitted to the hospital, ITD use with HTH had the most impact on survival to discharge with CPC≤2 of 24%. Conclusions: Therapies (ITD, MCPR, HTH) developed to enhance circulation during CPR and cerebral recovery after ROSC, significantly improved survival with favorable neurological function by 80% following OHCA.

scholarly journals Incidence and Outcomes of Out‐of‐Hospital Cardiac Arrest in Singapore and Victoria: A Collaborative Study

2020 ◽  
Vol 9 (21) ◽  
Author(s):  
Shir Lynn Lim ◽  
Karen Smith ◽  
Kylie Dyson ◽  
Siew Pang Chan ◽  
Arul Earnest ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Cardiopulmonary Resuscitation ◽  
Emergency Medical Services ◽  
Prehospital Care ◽  
Survival Rates ◽  
World Health ◽  
Medical Services ◽  
Emergency Medical ◽  
Bystander Cardiopulmonary Resuscitation ◽  
Hospital Cardiac Arrest

Background Incidence and outcomes of out‐of‐hospital cardiac arrest (OHCA) vary between communities. We aimed to examine differences in patient characteristics, prehospital care, and outcomes in Singapore and Victoria. Methods and Results Using the prospective Singapore Pan‐Asian Resuscitation Outcomes Study and Victorian Ambulance Cardiac Arrest Registry, we identified 11 061 and 32 003 emergency medical services‐attended adult OHCAs between 2011 and 2016 respectively. Incidence and survival rates were directly age adjusted using the World Health Organization population. Survival was analyzed with logistic regression, with model selection via backward elimination. Of the 11 061 and 14 834 emergency medical services‐treated OHCAs (overall mean age±SD 65.5±17.2; 67.4% males) in Singapore and Victoria respectively, 11 054 (99.9%) and 5595 (37.7%) were transported, and 440 (4.0%) and 2009 (13.6%) survived. Compared with Victoria, people with OHCA in Singapore were older (66.7±16.5 versus 64.6±17.7), had less shockable rhythms (17.7% versus 30.3%), and received less bystander cardiopulmonary resuscitation (45.7% versus 58.5%) and defibrillation (1.3% versus 2.5%) (all P <0.001). Age‐adjusted OHCA incidence and survival rates increased in Singapore between 2011 and 2016 ( P <0.01 for trend), but remained stable, though higher, in Victoria. Likelihood of survival increased significantly ( P <0.001) with arrest in public locations (adjusted odds ratio [aOR] 1.81), witnessed arrest (aOR 2.14), bystander cardiopulmonary resuscitation (aOR 1.72), initial shockable rhythm (aOR 9.82), and bystander defibrillation (aOR 2.04) but decreased with increasing age (aOR 0.98) and emergency medical services response time (aOR 0.91). Conclusions Singapore reported increasing OHCA incidence and survival rates between 2011 and 2016, compared with stable, albeit higher, rates in Victoria. Survival differences might be related to different emergency medical services practices including patient selection for resuscitation and transport.

scholarly journals The Pancreas in Child Abuse

2018 ◽  
Vol 8 (2) ◽  
pp. 219-238
Author(s):  
Katherine Callahan ◽  
Laura D. Knight
Keyword(s):  
Young Children ◽  
Motor Vehicle ◽  
Pancreatic Injury ◽  
Minor Trauma ◽  
Blunt Force ◽  
Nonaccidental Trauma ◽  
Vehicle Collision ◽  
Pancreatic Injuries ◽  
Injury Mechanisms ◽  
Bicycle Handlebar Injury

The pancreas can be a critical indicator of inflicted injury in young children. Due to its retroperitoneal location and the amount of incursion of the abdomen required to cause injury, the pancreas is unlikely to be significantly injured in minor trauma incidents. Typical blunt force injury mechanisms for the pancreas include motor vehicle collisions, inflicted injury from blows or kicks, and bicycle handlebar injuries with deep incursion of the abdomen. The death of a toddler is described in which a pancreatic injury was a critical indicator of abusive injury rather than the claimed accidental fall or cardiopulmonary resuscitation-related trauma. Review of the medical literature regarding the epidemiology, etiology, and pathology of childhood pancreatic injuries is discussed. Pancreatic injury is a marker of severe blunt force trauma and should rouse a suspicion of nonaccidental trauma in young children. In the absence of a severe, high velocity or deep abdominal incursion traumatic mechanism, such as motor vehicle collision or bicycle handlebar injury, pancreatic laceration specifically is a marker of inflicted injury in children under the age of five. Acad Forensic Pathol. 2018 8(2): 219-238

scholarly journals Impact of specific emergency measures on survival of out of hospital traumatic cardiac arrest: data from the northern french alps cardiac arrest registry.

2020 ◽  
Author(s):  
Dominique Savary ◽  
François Morin ◽  
Delphine Douillet ◽  
Thierry Roupioz ◽  
François Xavier Ageron ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Life Support ◽  
Cerebral Performance Category ◽  
Tension Pneumothorax ◽  
Advanced Life Support ◽  
Traumatic Cardiac Arrest ◽  
Advanced Airway ◽  
Good Neurologic Outcome ◽  
Pelvic Stabilization ◽  
The Impact

Abstract The management of Out of hospital Traumatic Cardiac Arrest (TCA) for professional rescuers combines advanced life support with specifics actions to treat potential reversible causes of the arrest: hypovolemia, hypoxemia, Tension Pneumothorax (TPx) and tamponade. The aim of this study was to assess the impact of specific rescue gestures on short-term outcomes in the context of resuscitation of patients with a pre-hospital TCA.Methods: We conducted a retrospective study of all TCA treated in two emergency medical units (EM unit), which are part of the Northern Alps emergency network, from January 2004 to December 2017. Utstein variables and specific rescue actions in TCA were compiled: advanced airway management, fluid administration, pelvic stabilization or tourniquet application, bilateral thoracostomy, and thoracotomy procedures. The primary end point was the survival rate at day 30 with good neurologic outcome (cerebral performance category [CPC] score 1 & 2).Results: 287 resuscitations attempt in TCA were included and 279 specific interventions were Identified: 262 Fluid expansion, 41 External Pelvic stabilizations, 5 tourniquets, 175 bilateral thoracostomies, (including 44 with TPx).Conclusion: Among standard resuscitation measures to treat reversible causes of cardiac arrest, we were able to show that bilateral thoracostomy and tourniquet application on a limb hemorrhage improves survival of TCA. A larger sample for pelvic stabilization is necessary.

Complication Rates for the Esophageal Obturator Airway and Endotracheal Tube in the Prehospital Setting

1993 ◽  
Vol 8 (2) ◽  
pp. 117-121 ◽  
Author(s):  
Daniel G. Hankins ◽  
Nancy Carruthers ◽  
R. J. Frascone ◽  
Linda Ann Long ◽  
Brian C. Campion
Keyword(s):  
Cardiac Arrest ◽  
Endotracheal Tube ◽  
Complication Rate ◽  
Prehospital Care ◽  
Survival Rates ◽  
Complication Rates ◽  
Quasi Experimental ◽  
Continued Use ◽  
Prehospital Cardiac Arrest ◽  
Careful Thought

AbstractPurpose:The purpose of this study was to determine the complication rates associated with the use of the endotracheal tube (ET) a the use of the esophageal obturator airway/esophageal gastric tube airway (EOA/EGT during the treatment of patients with prehospital cardiac arrest.Methods:A descriptive, quasi-experimental study of 509 consecutive adults, cardiac arrest patients was conducted. Patients were examined prospectively for airway intervention type and complications. Some patients were examined at their final destinations (field, morgue, funeral home), while other patients were examined by EMS providers in the field when airway adjuncts were switched. Also, airways were evaluated for complications by emergency physicians at destination emergency departments.Results:The airway in use at the time of examination was the esophageal obturator airway (EOA) or esophageal gas lube airway (EGTA) in 208 patients (40.1%); the ET (endotracheal tube) in 232 patients (45.6%); and an oral or nasopha ryngeal airway in 47 patients (9.2%). Twenty-two patients (4.3%) had both an EOA/EGTA and an ET tube in place at the time of the examination. The survival rates were similar between the EOA/EGTA and the ET groups (28% and 32%, respectively). The complication rates overall also were similar, but the serious or potentially lethal complication rate was 3.3 times more common with the use of the EOA/EGTA than with the ET tube (8.7% versus 2.6%, respectively).Conclusions:The complication rate for the EOA/EGTA is unacceptably high, and careful thought must be given to its continued use. Serious questions also arise concerning the complication rates associated with the use of the ET: is the complication rate of 2.5% acceptable or should other airway alternative be considered for use in prehospital care?

scholarly journals Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Hiromichi Naito ◽  
Tetsuya Yumoto ◽  
Takashi Yorifuji ◽  
Tsuyoshi Nojima ◽  
Hirotsugu Yamamoto ◽  
...  
Keyword(s):  
Cardiac Arrest ◽  
Survival Rate ◽  
Risk Ratio ◽  
Injury Severity ◽  
Burn Injury ◽  
Survival Curve ◽  
Clinical Signs ◽  
Transport Time ◽  
Traumatic Cardiac Arrest ◽  
Emergency Medical

Abstract Background Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. In 2003, the joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposed stopping unsuccessful cardiopulmonary resuscitation (CPR) sustained for > 15 min after TCA. However, in 2013, a specific time-limit for terminating resuscitation was dropped, due to the lack of conclusive studies or data. We aimed to define the association between emergency medical services transport time and survival to demonstrate the survival curve of TCA. Methods A retrospective review of the Japan Trauma Data Bank. Inclusion criteria were age ≥ 16, at least one trauma with Abbreviated Injury Scale score (AIS) ≥ 3, and CPR performed in a prehospital setting. Exclusion criteria were burn injury, AIS score of 6 in any region, and missing data. Estimated survival rate and risk ratio for survival were analyzed according to transport time for all patients. Analysis was also performed separately on patients with sustained TCA at arrival. Results Of 292,027 patients in the database, 5336 were included in the study with 4141 sustained TCA. Their median age was 53 years (interquartile range (IQR) 36–70), and 67.2% were male. Their median Injury Severity Score was 29 (IQR 22–41), and median transport time was 11 min (IQR 6–17). Overall survival after TCA was 4.5%; however, survival of patients with sustained TCA at arrival was only 1.2%. The estimated survival rate and risk ratio for sustained TCA rapidly decreased after 15 min of transport time, with estimated survival falling below 1%. Conclusion The chances of survival for sustained TCA declined rapidly while the patient is transported with CPR support. Time should be one reasonable factor for considering termination of resuscitation in patients with sustained TCA, although clinical signs of life, and type and severity of trauma should be taken into account clinically.

Abstract 247: Cardiac Arrest Management in Rural Prehospital Care

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_4) ◽  
Author(s):  
Gregory A Peters ◽  
Alexander Ordoobadi ◽  
Rebecca E Cash ◽  
Ashish Panchal
Keyword(s):  
Logistic Regression ◽  
Cardiac Arrest ◽  
Response Time ◽  
Life Support ◽  
Prehospital Care ◽  
Epinephrine Administration ◽  
Support Unit ◽  
Multivariable Logistic Regression ◽  
Advanced Airway ◽  
Mechanical Cpr

Introduction: Rural prehospital care settings are underrepresented in the out-of-hospital cardiac arrest (OHCA) literature. We analyzed a nationwide database of emergency medical services (EMS) incidents in the US to describe treatment patterns and the odds of return of spontaneous circulation (ROSC) among rural OHCA patients. Methods: Using the 2018 National EMS Informational System dataset, we analyzed OHCA incidents where CPR provided by EMS was documented. We excluded incidents in which trauma was involved, patient age <18 years, transport was not by completed by an advanced life support unit, or response time >60 minutes. The primary outcome was ROSC during the EMS incident. Multivariable logistic regression was performed comparing rural, suburban, and urban settings while controlling for age and gender, incident location type, response time, CPR prior to EMS arrival, arrest witnessed by EMS, initial rhythm, epinephrine administration, mechanical CPR, and advanced airway used. Results: A total of 60,281 OHCA incidents were identified for inclusion, including 5,013 (8.6%) in rural settings. Rural OHCA patients achieved ROSC in 28.8% of cases, compared to 33.0% in urban or suburban settings (p<0.001). Neither age nor gender significantly differed between settings (Table 1). Rural OHCA incidents had greater response times (7.5 vs. 5.9 minutes, p<0.001) and were less likely to receive epinephrine (71.6% vs. 74.9%, p<0.001). Further, EMS were more likely to use mechanical CPR (29.8% vs. 28.1%, p=0.01) and less likely to provide an advanced airway (56.3% vs. 50.5%, p<0.001) for rural OHCA. On multivariable logistic regression, rural OHCA patients had lower odds of achieving ROSC than urban OHCA patients after controlling for other factors (0.80, 95%CI: 0.75-0.86). Conclusion: In this national sample of EMS-treated OHCA, rural patients were less likely to achieve ROSC than patients in urban or suburban settings.

scholarly journals Nurses and advanced airway management: the experience of the Piacenza ambulance service

2015 ◽  
Vol 11 (2) ◽  
Author(s):  
Fabio Mozzarelli ◽  
Kezia Vigevani ◽  
Stefano Nani ◽  
Andrea Vercelli ◽  
Enrica Rossi
Keyword(s):  
Cardiac Arrest ◽  
Airway Management ◽  
Sudden Cardiac Arrest ◽  
Ambulance Service ◽  
Local Health Authority ◽  
Local Health ◽  
Traumatic Cardiac Arrest ◽  
Advanced Airway ◽  
Specific Medication ◽  
Observational Design

The study examined the intubation manoeuvres performed by Piacenza local health authority ambulance service nurses in patients with sudden cardiac arrest of nontraumatic origin. The study has a retrospective observational design and analyzes all the intubation manoeuvres performed by ambulance service nurses in patients with non-traumatic cardiac arrest between January 2010 and December 2013. The success of the procedure with subglottic tubes was 97.7% (P&gt;0.60), while it was 100% (P&gt;0.50) with supraglottic devices. The success rate of the procedures is encouraging and the statistical analysis showed that there are no significant differences between literature data and the experience of Piacenza ambulance system crews. An increase in the use of supraglottic devices was also observed. The results show that the Piacenza ambulance service nursing staff has a good level of skills and competence in advanced airway management. A future development of this ability could involve intubation also in situations other than cardiac arrest using specific medication.

Case Exercise: Biomechanics in Rearend Motor Vehicle Collisions

2007 ◽  
Vol 12 (3) ◽  
pp. 4-7
Author(s):  
Charles N. Brooks ◽  
Christopher R. Brigham
Keyword(s):  
Motor Vehicle ◽  
Body Position ◽  
Motor Vehicle Collisions ◽  
Time Curve ◽  
Vehicle Collisions ◽  
Need For Treatment ◽  
Multiple Factors ◽  
Bodily Injury ◽  
Vehicle Collision ◽  
Physical Findings

Abstract Multiple factors determine the likelihood, type, and severity of bodily injury following a motor vehicle collision and, in turn, influence the need for treatment, extent of disability, and likelihood of permanent impairment. Among the most important factors is the change in velocity due to an impact (Δv). Other factors include the individual's strength and elasticity, body position at the time of impact, awareness of the impending impact (ie, opportunity to brace, guard, or contract muscles before an impact), and effects of braking. Because Δv is the area under the acceleration vs time curve, it combines force and duration and is a useful way to quantify impact severity. The article includes a table showing the results of a literature review that concluded, “the consensus of human subject research conducted to date is that a single exposure to a rear-end impact with a Δv of 5 mph or less is unlikely to result in injury” in most healthy, restrained occupants. Because velocity incorporates direction as well as speed, a vehicular occupant is less likely to be injured in a rear impact than when struck from the side. Evaluators must consider multiple factors, including the occupant's pre-existing physical and psychosocial status, the mechanism and magnitude of the collision, and a variety of biomechanical variables. Recommendations based solely on patient history and physical findings (and, perhaps, imaging studies) may be ill-informed.

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