Abstract
Introduction
Many consider attempted resuscitation for traumatic out-of-hospital cardiac arrest
(OHCA) futile. This study aims to describe the characteristics and profile of adult
traumatic OHCA.
Methods
The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all trauma
related cases of OHCA in patients aged ≥16 years.
Results
Between 2000 and 2009, EMS attended 33,178 OHCAs of which 2187 (6.6%) had a traumatic
aetiology. The median age (IQR) of traumatic OHCA cases was 36 (25–55) years and 1612
were male (77.5%). Bystander CPR was performed in 201 cases (10.2%) with median (IQR)
EMS response time 8 (6–11) min. The first recorded rhythm by EMS was asystole seen in 1650 (75.4%), PEA in 294
(13.4%) cases and VF in 35 cases (1.6%). Cardiac output was present in 208 (9.5%)
cases who subsequently had an EMS witnessed OHCA. EMS attempted resuscitation in 545
(24.9%) patients of whom 84 (15.4%) achieved ROSC and were transported, and 27 (5.1%)
survived to hospital discharge; 107 were transported with CPR of whom 8 (7.4%) survived
to hospital discharge. Where EMS attempted resuscitation in traumatic OHCAs, survival
for VF was 11.8% (n = 4), PEA 5.1% (n = 10) and asystole 2.4% (n = 3). In EMS witnessed traumatic OHCA, resuscitation was attempted in 175 cases (84.1%),
35 (16.8%) patients achieved sustained ROSC before transport of whom 5 (14%) survived
to leave hospital and 60 (28.8%) were transported with CPR of whom 6 (10%) survived
to leave hospital. Compared to OHCA cases with ‘presumed cardiac’ aetiology traumatic
OHCAs were younger [median years (IQR): 36 (25–55) vs 74 (61–82)], had resuscitation
attempted less (25% vs 48%), were less likely to have a shockable rhythm (1.6% vs
17.1%), were more likely to be witnessed (62.8% vs 38.1%) and were less likely to
receive bystander CPR (10.2% vs 25.5%) (p < 0.001, respectively). Multivariate logistic regression identified factors associated
with EMS decision to attempt resuscitation. The odds ratio [OR (95% CI)] for ‘presence
of bystander CPR’ was 5.94 (4.11–8.58) and for ‘witnessed arrest’ was 2.60 (1.86–3.63).
Conclusion
In this paramedic delivered EMS attempted resuscitation was not always futile in traumatic
OHCA with a survival of 5.1%. The quality of survival needs further study.
Keywords
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Article info
Publication history
Published online: October 12, 2011
Accepted:
September 26,
2011
Received in revised form:
September 12,
2011
Received:
May 13,
2011
Footnotes
☆A Spanish translated version of the abstract of this article appears as Appendix in the final online version at doi:10.1016/j.resuscitation.2011.09.025.
Identification
Copyright
© 2011 Elsevier Ireland Ltd. Published by Elsevier Inc. All rights reserved.
