Abstract 17: Prehospital Interventions Associated with Survival from Traumatic Cardiac Arrest
Traumatic cardiac arrest has traditionally been associated with a dismal prognosis, but emerging evidence suggests that survival may be better than expected.
The objectives for this study were to 1) describe the contemporary management and outcomes of traumatic arrest; and 2) identify prehospital interventions associated with survival to hospital discharge.
We completed a secondary analysis of traumatic arrest cases in the ROC Epistry-Trauma and PROPHET registries. Patients were included if they suffered a blunt or penetrating injury and received chest compressions in the field, regardless of whether they were ultimately transported to the hospital. Multivariable logistic regression analyses were used to generate odds ratios for survival to hospital discharge for the following interventions: advanced life support care, prehospital times, bag-mask ventilation, intubation, supraglottic airway, needle thoracostomy, hemorrhage control, and IV/IO fluids.
The study population included 2248 traumatic arrest patients who were predominately young (mean 39 ± 20 years), males (78%), with blunt injuries (68%), without vital signs on EMS arrival (67%), and attended to by advanced life support paramedic crews (87%). A total of 193 patients (8.6%) survived to hospital discharge. More patients with blunt trauma (11%) compared to penetrating trauma (4.5%) survived. The majority (87%) of survivors had at least one vital sign on EMS arrival. Frequently performed procedures were bag-mask ventilation (86%), intubation (55%), and IV fluids (53%). All other procedures were performed in ≤ 15% of patients. Bag-mask ventilation (adjusted OR: 0.26, 95% CI 0.15, 0.44), intubation (adjusted OR: 0.45, 95% CI 0.265 to 0.764), and hemorrhage control (adjusted OR: 0.43, 95% CI 0.20 to 0.93) were all associated with a decreased odds of surviving to hospital discharge following blunt traumatic arrest. No other procedures significantly altered the odds of surviving to hospital discharge.
We conclude that survival from traumatic arrest may be higher than previously thought, particularly in blunt trauma, and in those with at least one vital sign on EMS arrival. Frequently performed prehospital interventions were not associated with improved survival from traumatic arrest.
Author Disclosures: C. Evans: None. A. Petersen: None. M. Schreiber: None. D. Kannas: None. J. Buick: None. M. Austin: None. D. Dean: None.
This research has received full or partial funding support from the American Heart Association.
- © 2014 by American Heart Association, Inc.