Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries

Christopher C D Evans, Ashley Petersen, Eric N. Meier, Jason E. Buick, Martin Schreiber, Delores Kannas, Michael A. Austin

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. RESULTS: We included 2, 300 patients who were predominately young (Epistry mean [SD], 39 [20]years; PROPHET mean [SD], 40[19] years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6. 3%) survived to hospital discharge. More patients with blunt (Epistry, 8. 3%; PROPHET, 6. 5%) vs. penetrating injuries (Epistry, 4. 6%; PROPHET, 2. 7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0. 048) in the Epistry but not PROPHET (p = 0. 14) registries. Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0. 27; 95% confidence interval, 0. 08-0. 93; and 0. 37; 95% confidence interval, 0. 17-0. 78, respectively) compared to those receiving bag-mask ventilation. No other procedureswere associatedwith survival. CONCLUSIONS: Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased odds of survival.

    Original languageEnglish (US)
    Pages (from-to)285-293
    Number of pages9
    JournalJournal of Trauma and Acute Care Surgery
    Volume81
    Issue number2
    DOIs
    StatePublished - 2016

    Fingerprint

    Heart Arrest
    Resuscitation
    Registries
    Wounds and Injuries
    Survival
    Emergency Medical Services
    Survival Rate
    Confidence Intervals
    Allied Health Personnel
    Cardiopulmonary Resuscitation
    Masks
    Intubation
    Survivors
    Logistic Models
    Regression Analysis

    Keywords

    • Cardiac arrest
    • Emergency medical services
    • Intubation
    • Prehospital
    • Resuscitation

    ASJC Scopus subject areas

    • Critical Care and Intensive Care Medicine
    • Surgery

    Cite this

    Prehospital traumatic cardiac arrest : Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. / Evans, Christopher C D; Petersen, Ashley; Meier, Eric N.; Buick, Jason E.; Schreiber, Martin; Kannas, Delores; Austin, Michael A.

    In: Journal of Trauma and Acute Care Surgery, Vol. 81, No. 2, 2016, p. 285-293.

    Research output: Contribution to journalArticle

    Evans, Christopher C D ; Petersen, Ashley ; Meier, Eric N. ; Buick, Jason E. ; Schreiber, Martin ; Kannas, Delores ; Austin, Michael A. / Prehospital traumatic cardiac arrest : Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. In: Journal of Trauma and Acute Care Surgery. 2016 ; Vol. 81, No. 2. pp. 285-293.
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    abstract = "BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. RESULTS: We included 2, 300 patients who were predominately young (Epistry mean [SD], 39 [20]years; PROPHET mean [SD], 40[19] years), males (79{\%}), injured by blunt trauma (Epistry, 68{\%}; PROPHET, 67{\%}), and treated by ALS paramedics (Epistry, 93{\%}; PROPHET, 98{\%}). A total of 145 patients (6. 3{\%}) survived to hospital discharge. More patients with blunt (Epistry, 8. 3{\%}; PROPHET, 6. 5{\%}) vs. penetrating injuries (Epistry, 4. 6{\%}; PROPHET, 2. 7{\%}) survived. Most survivors (81{\%}) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0. 048) in the Epistry but not PROPHET (p = 0. 14) registries. Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0. 27; 95{\%} confidence interval, 0. 08-0. 93; and 0. 37; 95{\%} confidence interval, 0. 17-0. 78, respectively) compared to those receiving bag-mask ventilation. No other procedureswere associatedwith survival. CONCLUSIONS: Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased odds of survival.",
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    T2 - Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries

    AU - Evans, Christopher C D

    AU - Petersen, Ashley

    AU - Meier, Eric N.

    AU - Buick, Jason E.

    AU - Schreiber, Martin

    AU - Kannas, Delores

    AU - Austin, Michael A.

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    N2 - BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. RESULTS: We included 2, 300 patients who were predominately young (Epistry mean [SD], 39 [20]years; PROPHET mean [SD], 40[19] years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6. 3%) survived to hospital discharge. More patients with blunt (Epistry, 8. 3%; PROPHET, 6. 5%) vs. penetrating injuries (Epistry, 4. 6%; PROPHET, 2. 7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0. 048) in the Epistry but not PROPHET (p = 0. 14) registries. Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0. 27; 95% confidence interval, 0. 08-0. 93; and 0. 37; 95% confidence interval, 0. 17-0. 78, respectively) compared to those receiving bag-mask ventilation. No other procedureswere associatedwith survival. CONCLUSIONS: Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased odds of survival.

    AB - BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. RESULTS: We included 2, 300 patients who were predominately young (Epistry mean [SD], 39 [20]years; PROPHET mean [SD], 40[19] years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6. 3%) survived to hospital discharge. More patients with blunt (Epistry, 8. 3%; PROPHET, 6. 5%) vs. penetrating injuries (Epistry, 4. 6%; PROPHET, 2. 7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0. 048) in the Epistry but not PROPHET (p = 0. 14) registries. Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0. 27; 95% confidence interval, 0. 08-0. 93; and 0. 37; 95% confidence interval, 0. 17-0. 78, respectively) compared to those receiving bag-mask ventilation. No other procedureswere associatedwith survival. CONCLUSIONS: Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased odds of survival.

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    KW - Emergency medical services

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    KW - Prehospital

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