Abstract
Aim
To evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines
on patient outcomes following traumatic cardiac arrest (TCA) and on advanced life
support interventions carried out by physician-staffed ambulances.
Methods
Data of TCA patients aged ≥18 years were extracted from the French nationwide cardiac
arrest registry. A pre- (2011–2015) and a post-publication period (2016–2020) were
defined. In the guidelines, a specific TCA management algorithm was introduced to
prioritise the treatment of reversible causes. Its impact was evaluated using adjusted
interrupted time series analysis.
Results
4,980 patients were treated (2,145 during the pre-publication period and 2,739 during
the post-publication period). There was no significant change in the rates of prehospital
ROSC (22.4% vs. 20.2%, p = 0.07 in the pre- and post- intervention respectively), survival (1.4% vs. 1.4%, p = 0.87) or good neurological outcome (71.4% vs. 66.7%, p = 0.93) or in the incidence of organ donation (1.6% vs. 1.3%, p = 0.50). There were nonsignificant changes in the adjusted temporal trend for ROSC
(aOR 0.88; 95% CI [0.77; 1.00]), survival (aOR 1.34; 95% CI [0.83;2.17]), good neurological
outcome (aOR 1.57; 95% CI [0.82;3.05]), and organ donation (aOR 1.06; 95% CI [0.71;1.60]).
The use of intraosseous catheters (13.0% vs. 19.2%, p < 0.001), external haemorrhage control measures (23.9% vs. 64.8%, p < 0.001), bilateral chest decompression (13.7% vs. 16.5%, p = 0.009), and packed red cell transfusion (2.7% vs. 6.5%, p < 0.001) increased in the post-publication period.
Conclusions
Despite the increased frequency of trauma rescue interventions performed by on-scene
physicians, no change in patient-centred outcomes was associated with the publication
of the 2015 ERC guidelines in France.
Keywords
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Article info
Publication history
Published online: March 14, 2023
Accepted:
March 3,
2023
Received in revised form:
February 19,
2023
Received:
December 22,
2022
Identification
Copyright
© 2023 Elsevier B.V. All rights reserved.
