TY - JOUR
T1 - Prehospital traumatic cardiac arrest
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.
N1 - Publisher Copyright:
Copyright © 2016 Wolters Kluwer Health, Inc. All rights reserved.
PY - 2016
Y1 - 2016
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.
KW - Cardiac arrest
KW - Emergency medical services
KW - Intubation
KW - Prehospital
KW - Resuscitation
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U2 - 10.1097/TA.0000000000001070
DO - 10.1097/TA.0000000000001070
M3 - Article
C2 - 27070438
AN - SCOPUS:84963699482
SN - 2163-0755
VL - 81
SP - 285
EP - 293
JO - Journal of Trauma and Acute Care Surgery
JF - Journal of Trauma and Acute Care Surgery
IS - 2
ER -