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

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.

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Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

10.21203/rs.2.19571/v1 ◽

2020 ◽

Author(s):

Peter Hilbert-Carius ◽

David T McGreevy ◽

Fikri M. Abu-Zidan ◽

Tal M. Hörer

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

Hospital Admission ◽

Injury Severity ◽

Balloon Occlusion ◽

Trauma Patients ◽

Probability Of Survival ◽

Traumatic Cardiac Arrest ◽

Using Data

Abstract Background: Severely injured trauma patients suffering from traumatic cardiac arrest (TCA) and requiring cardiopulmonary resuscitation (CPR) rarely survive. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) performed early after hospital admission in patients with TCA is not well-defined. As the use of REBOA increases, there is great interest in knowing if there is a survival benefit related to the early use of REBOA after TCA. Using data from the ABOTrauma Registry, we aimed to study the role of REBOA used early after hospital admission in trauma patients who required pre-hospital CPR. Methods: Retrospective and prospective data on the use of REBOA were collected from the ABOTrauma Registry from 11 centers in seven countries globally between 2014 and 2019. In all patients with pre-hospital TCA, the predicted probability of survival, calculated with the Revised Injury Severity Classification II (RISC II), was compared with the observed survival rate. Results: Of 213 patients in the ABOTrauma Registry, 26 patients (12.2%) who had received pre-hospital CPR were identified. The median (range) Injury Severity Score (ISS) was 45.5 (25-75). Fourteen patients (54%) had been admitted to hospital with ongoing CPR. Nine patients (35%) died within the first 24 hours, while seventeen patients (65%) survived post 24 hours. The survival rate to hospital discharge was 27% (n=7). The predicted mortality using the RISC II was 0.977 (25 out of 26). The observed mortality (19 out of 26) was significantly lower than the predicted mortality (p=0.049). Patients not responding to REBOA were more likely to die. Only one (10%) out of 10 non-responders survived. Survival rate in the 16 patients responding to REBOA was 37.5% (n=6). REBOA with a median (range) duration of 45 (8-70) minutes significantly increases blood pressure from median (range) 56.5 (0-147) to 90 (0-200) mmHg. Conclusions: Mortality in patients suffering from TCA and receiving REBOA early after hospital admission is significantly lower than predicted by the RISC II. REBOA may improve survival after TCA. The use of REBOA in these patients should be further investigated. Keywords: REBOA, Cardiac Arrest, Trauma, CPR, Endovascular Resuscitation.

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Pre-hospital CPR and early REBOA in trauma patients - Results from the ABOTrauma Registry.

10.21203/rs.2.19571/v2 ◽

2020 ◽

Author(s):

Peter Hilbert-Carius ◽

David T McGreevy ◽

Fikri M. Abu-Zidan ◽

Tal M. Hörer

Keyword(s):

Survival Rate ◽

Hospital Admission ◽

Injury Severity ◽

Balloon Occlusion ◽

Trauma Patients ◽

Probability Of Survival ◽

Traumatic Cardiac Arrest ◽

Predicted Probability ◽

Using Data

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

Emergency Medicine Journal ◽

10.1136/emermed-2021-211723 ◽

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.

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Traumatic cardiac arrest is associated with lower survival rate vs. medical cardiac arrest – Results from the French national registry

Resuscitation ◽

10.1016/j.resuscitation.2018.07.032 ◽

2018 ◽

Vol 131 ◽

pp. 48-54 ◽

Cited By ~ 8

Author(s):

Joséphine Escutnaire ◽

Michael Genin ◽

Evgéniya Babykina ◽

Cyrielle Dumont ◽

François Javaudin ◽

...

Keyword(s):

Cardiac Arrest ◽

Survival Rate ◽

National Registry ◽

Lower Survival Rate ◽

Lower Survival ◽

Traumatic Cardiac Arrest

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Emergency medical dispatch recognition, clinical intervention and outcome of patients in traumatic cardiac arrest from major trauma: an observational study

BMJ Open ◽

10.1136/bmjopen-2018-022464 ◽

2018 ◽

Vol 8 (9) ◽

pp. e022464

Author(s):

Craig Prentice ◽

Jeyasankar Jeyanathan ◽

Richard De Coverly ◽

Julia Williams ◽

Richard Lyon

Keyword(s):

Cardiac Arrest ◽

Significant Proportion ◽

Helicopter Emergency Medical Service ◽

Medical Intervention ◽

Emergency Call ◽

Blood Product Transfusion ◽

Emergency Medical Dispatch ◽

Resuscitative Thoracotomy ◽

Traumatic Cardiac Arrest ◽

Emergency Medical

ObjectivesThe aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate.SettingHelicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people.ParticipantsPatients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust’s geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected.Outcome measuresPatient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates.Results112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the ‘not in TCA cohort’, 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital.ConclusionA significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.

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Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed helicopter emergency medical service

Critical Care ◽

10.1186/cc12504 ◽

2013 ◽

Vol 17 (2) ◽

pp. 308 ◽

Cited By ~ 33

Author(s):

Peter Sherren ◽

Cliff Reid ◽

Karel Habig ◽

Brian J Burns

Keyword(s):

Cardiac Arrest ◽

Emergency Medical Service ◽

Medical Service ◽

Helicopter Emergency Medical Service ◽

Traumatic Cardiac Arrest ◽

Emergency Medical

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Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales

Archives of Disease in Childhood ◽

10.1136/archdischild-2018-314985 ◽

2018 ◽

Vol 104 (5) ◽

pp. 437-443 ◽

Cited By ~ 3

Author(s):

James Vassallo ◽

Melanie Webster ◽

Edward B G Barnard ◽

Mark D Lyttle ◽

Jason E Smith

Keyword(s):

Cardiac Arrest ◽

Injury Severity ◽

Road Traffic ◽

Population Based ◽

Trauma Centre ◽

Research Network ◽

Common Mechanism ◽

England And Wales ◽

Traumatic Cardiac Arrest ◽

Major Trauma Centre

ObjectiveTo describe the epidemiology and aetiology of paediatric traumatic cardiac arrest (TCA) in England and Wales.DesignPopulation-based analysis of the UK Trauma Audit and Research Network (TARN) database.Patients and settingAll paediatric and adolescent patients with TCA recorded on the TARN database for a 10-year period (2006–2015).MeasuresPatient demographics, Injury Severity Score (ISS), location of TCA (‘prehospital only’, ‘in-hospital only’ or ‘both’), interventions performed and outcome.Results21 710 paediatric patients were included in the database; 129 (0.6%) sustained TCA meeting study inclusion criteria. The majority, 103 (79.8%), had a prehospital TCA. 62.8% were male, with a median age of 11.7 (3.4–16.6) years, and a median ISS of 34 (25–45). 110 (85.3%) had blunt injuries, with road-traffic collision the most common mechanism (n=73, 56.6%). 123 (95.3%) had severe haemorrhage and/or traumatic brain injury. Overall 30-day survival was 5.4% ((95% CI 2.6 to 10.8), n=7). ‘Pre-hospital only’ TCA was associated with significantly higher survival (n=6) than those with TCA in both ‘pre-hospital and in-hospital’ (n=1)—13.0% (95% CI 6.1% to 25.7%) and 1.2% (95% CI 0.1% to 6.4%), respectively, p<0.05. The greatest survival (n=6, 10.3% (95% CI 4.8% to 20.8%)) was observed in those transported to a paediatric major trauma centre (MTC) (defined as either a paediatric-only MTC or combined adult-paediatric MTC).ConclusionsSurvival is possible from the resuscitation of children in TCA, with overall survival comparable to that reported in adults. The highest survival was observed in those with a pre-hospital only TCA, and those who were transported to an MTC. Early identification and aggressive management of paediatric TCA is advocated.

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Emergency Medical Service Transport Time and Trauma Outcomes at an Urban Level 1 Trauma Center: Evaluation of Prehospital Emergency Medical Service Response

The American Surgeon ◽

10.1177/0003134820988827 ◽

2021 ◽

pp. 000313482098882

Author(s):

Adel Elkbuli ◽

Brianna Dowd ◽

Carol Sanchez ◽

Saamia Shaikh ◽

Mason Sutherland ◽

...

Keyword(s):

Emergency Medical Service ◽

Trauma Center ◽

Medical Service ◽

Injury Severity ◽

Future Research ◽

Trauma Patients ◽

Transport Time ◽

Emergency Medical ◽

Level 1 ◽

Level 1 Trauma Center

Background The use of helicopter emergency medical services (HEMS) for trauma patients has been debated since its introduction. We aim to compare outcomes for trauma patients transported by ground EMS (GEMS) vs. HEMS using raw and adjusted mortality in a level 1 trauma center. Methods A 6-year retrospective cohort study utilizing our level 1 trauma center registry for patients transferred by GEMS or HEMS was performed. Demographics and outcome measures were compared. Raw and adjusted mortality was evaluated. Adjusted mortality was determined incorporating confounders, including patient demographics, comorbid conditions, mechanism of injury, injury severity score (ISS), Glasgow Coma Scale score, and EMS transport time. Chi-square, multivariable logistic regression, and independent sample T-test were utilized with significance, defined as P < .05. Results Of 12 633 patients, 10 656 were transported via GEMS and 1977 with HEMS. Mean age was 55 for GEMS and 40 for HEMS ( P < .001). Mean ISS was 9.29 and 11.73 for GEMS and HEMS ( P < .001). Mean Revised Trauma Score was higher (less severe) for GEMS vs. HEMS (7.6 vs. 7.12, P < .001). Mean transport times for GEMS and HEMS was 39.45 vs. 47.29 minutes ( P = .02). Raw mortality was 2.55% (307/10 656) for GEMS and 6.78% (134/1977) for HEMS. Adjusted mortality revealed a 16.6% increased mortality for GEMS compared to HEMS (adjusted odds ratio = 1.166, 95% CI: .815-1.668). Conclusions Air-lifted trauma patients were younger, more severely injured, and more hemodynamically unstable and required longer transport time but experienced lower adjusted mortality. Future research is needed to investigate whether reducing transport times and augmenting the advanced care already implemented by HEMS crews can improve outcomes.

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Abstract 363: Just Another Post-Arrest?: Predicting Outcomes in Traumatic Arrest and Hemorrhagic Shock

Circulation ◽

10.1161/circ.142.suppl_4.363 ◽

2020 ◽

Vol 142 (Suppl_4) ◽

Author(s):

David T Poliner ◽

Daniel N Holena ◽

Mark Seamon ◽

Benjamin Abella

Keyword(s):

Cardiac Arrest ◽

Injury Severity ◽

Average Length ◽

Penetrating Trauma ◽

Length Of Hospital Stay ◽

Inpatient Rehabilitation ◽

Vital Statistics ◽

Spontaneous Circulation ◽

Traumatic Cardiac Arrest ◽

Trauma Outcome

Introduction: Traumatic cardiac arrest is a challenging presentation at trauma centers globally, with a high mortality and subsequent morbidity among survivors. For those who do obtain return of spontaneous circulation (ROSC), there is even less clarity with respect to how best to prognosticate outcomes. The previously derived and validated Pittsburgh Cardiac Arrest Categories (PCAC) have demonstrated value in predicting functional outcome and survival to hospital discharge in non-traumatic arrest. It is a 1 to 4 categorical score wherein a higher category is correlative to a worse clinical outcome. We hypothesized that the PCAC would be able to accurately predict outcomes in a trauma cohort. Methods: Utilizing the Pennsylvania Trauma Outcome System registry, 30 patients from 2018-2020 presented to a single, urban, tertiary trauma center with traumatic arrest. Demographics, vital statistics, injury patterns, and hospital course were abstracted and matched with subsequent PCAC scoring in accordance with previously published methods. Results: Population was predominantly male 16 (80%), black (75%) with a mean age 33 y (SD 13) . Penetrating trauma comprised 76% with average injury severity score of 38 (SD 22). Six (30%) were discharged alive with 5 requiring inpatient rehabilitation. Average length of hospital stay was 16 days (SD 18) with approximately 11 ventilator free days (SD 9). Average GFR at time of discharge was 44mg/dl (SD 31). The majority, 12 (57%), were PCAC 4 on arrival owing to predominant evidence of coma, 61%. By post-arrest day 1, there was a more even distribution between PCAC categories with category 2 (28%) and 3 (28%) each having 3 survivors and PCAC 4 (28%) having 2. By day 3, PCAC scores were less normally distributed with PCAC 1 having 6 survivors (42%) and PCAC 4 having 5 (35%). Day 1 and 3 categories continued to be driven principally be median Coma scores 0 (IQR: 0-8) but with regression of median SOFA cardiopulmonary scores 4 (IQR:0-6). SOFA Renal scores in survivors predictably increased from no injury to moderate dysfunction across this same period (IQR:1-4). Conclusion: PCAC scores in traumatic cardiac arrest patients who achieve ROSC do not predict multisystem organ failure but do predict neurologic outcome.

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