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

Evans, Christopher C.D. MD; Petersen, Ashley; Meier, Eric N. MS; Buick, Jason E. MSc, PCP; Schreiber, Martin MD; Kannas, Delores RN, MSN; Austin, Michael A. MBBSthe Resuscitation Outcomes Consortium Investigators

Journal of Trauma and Acute Care Surgery: August 2016 - Volume 81 - Issue 2 - p 285–293
doi: 10.1097/TA.0000000000001070
Original Articles
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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 procedures were associated with 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.

LEVEL OF EVIDENCE Prognostic study, level IV.

Supplemental digital content is available in the text.

From the Department of Emergency Medicine (C.C.D.E.), Queen's University, Kingston, Ontario, Canada; Department of Biostatistics (A.P., E.N.M.), University of Washington, Seattle, WA; Rescu, Li Ka Shing Knowledge Institute (J.E.B.), St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada; Department of Surgery (M.S.), Oregon Health and Science University, Portland, OR; Clinical Trials Center (K.D.), University of Washington, Seattle, WA; and Department of Emergency Medicine (M.A.), University of Ottawa, Ottawa, Ontario, Canada.

Submitted: October 7, 2015, Revised: February 21, 2016, Accepted: March 9, 2016, Published online: April 8, 2016.

Presented at the American Heart Association Resuscitation Science Symposium, November 16, 2014, in Chicago, Illinois.

Supplemental digital content is available for this article. Direct URL citations appear in the printed text, and links to the digital files are provided in the HTML text of this article on the journal’s Web site (www.jtrauma.com).

Address for reprints: Christopher Charles Douglas Evans, MD, FRCPC, Department of Emergency Medicine, Queen's University, Kingston General Hospital, 76 Stuart St, Kingston, Ontario, K7L 2 V7, Canada; email: c.evans@queensu.ca.

© 2016 Lippincott Williams & Wilkins, Inc.