Abstract 15898: Traumatic Injuries Related to Out-of-hospital Cardiac Arrest
Introduction: Fall-related injuries are a significant source of morbidity and mortality, and little is known about the injury patterns sustained as a result of falls precipitated by out-of-hospital cardiac arrest (OHCA). Survivors of OHCA are frequently triaged to initial care focused on cardiovascular needs, leading to unintended delays in identifying fall-related injuries.
Hypothesis: We hypothesize that comatose survivors of OHCA who sustain concurrent musculoskeletal injuries have higher mortality, longer ICU stays, and longer time to hospital discharge.
Methods: We retrospectively reviewed 413 consecutive comatose survivors of OHCA treated at Vanderbilt University Medical Center and included 249 patients with an initial shockable rhythm in the analysis. Concurrent traumatic injuries were identified using the admission history and physical, trauma documentation, imaging, and ICD-9/ICD-10 codes. Each case was adjudicated by two independent reviewers to ensure the injury sustained was caused by a fall related to the OHCA event. Injuries resulting from CPR were excluded.
Results: The majority of patients (139/249; 55.8%) survived to hospital discharge. Arrest-related traumatic injuries occurred in 45/249 (18.1%) patients. Injuries occurred in 28 (20.1%) survivors and 17 (15.5%) non-survivors (p=0.408). Length of ICU stay was significantly increased in survivors with concurrent traumatic injuries (10.4 days ± 10.3 vs 6.4 days ± 5.5, p=0.006). Length of hospital stay was increased in survivors with concurrent traumatic injuries (15.3 days ± 10.2 vs 12.4 days ± 7.5, p=0.096). Injury sites included head/neck (37/45, 82.2%), skin & soft tissue (25/45, 55.6%), and appendicular fractures (7/45, 15.6%). Intracranial hemorrhage was diagnosed in 8 patients (2.51%) and cervical spine fracture was identified in 3 patients (1.2%).
Conclusions: Injuries sustained as a result of falls related to OHCA are common, particularly in the head/neck area. Risk of OHCA-related trauma underscores the importance of a thorough primary survey prior to any further manipulation of the patient. Traumatic injuries related to OHCA do not appear to correlate with mortality or length of hospital stay but significantly impact the length of time within an ICU.
Author Disclosures: B.B. Holmes: None. W.C. Armstrong: None. N. Borges: None. M. Young: None. J.A. McPherson: None.
- © 2016 by American Heart Association, Inc.