Abstract 205: Termination of Resuscitation Rules for Traumatic Cardiopulmonary Arrest: Old Dogma, New Validation
Introduction: Pre-hospital terminations of resuscitation (TOR) rules for traumatic cardiopulmonary arrest (TCPA) have been proposed by the National Association Emergency Medical Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (ACSCOT) for a decade. However, validation studies from United Kingdom and Australia produced conflicting results. This study aimed to evaluate the performance of TOR rules for TCPA in an Asian metropolitan area.
Methods: We analyzed data from an Utstein registry system of adult patients with TCPA in Taipei to test the performance of the first guiding criteria of TOR for TCPA: blunt trauma patient found in asystole upon the arrival of emergency medical service (EMS) at the scene. Predictive outcome was in-hospital death. Test statistics including sensitivity, specificity, positive predictive value (PPV), negative predictive values (NPV), and decreased transport rate (DTR) were calculated.
Results: From Jan 1, 2008 to Dec 31, 2009, there were 328 adult patients with TCPA. The mechanism was blunt trauma in 155 (47.3%), penetrating trauma in 106 (32.3%) and uncertain in 106 (32.3%), and mechanisms were 155 (47.3%), 106 (32.3%), and 67 (20.4%). The presenting rhythm was asystole in 54/155 (34.8%) of blunt trauma, 57/107(53.3%) of penetrating trauma, and 28/67 (41.8%) of uncertain mechanism. Overall survival rate of TCPA (to hospital discharge) were 11/328 (3.4%). For those with blunt trauma, only 4 survived to hospital discharge (2.6%). The test statistics of the first guiding criteria (i.e. patients with blunt trauma and asystole) and sensitivity analysis by categorizing uncertain mechanism as blunt trauma were presented in the Table.
Conclusion: Application of the first rule of thumb proposed by NAEMSP and ACSCOT for adult patients with TCPA can accurately identify non-survivors (100% PPV and 100% specificity) and decrease unnecessary EMS transports (16.5%~25.0%) in an Asian Metropolitan area.
- © 2013 by American Heart Association, Inc.