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Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest
  1. François-Xavier Duchateau1,
  2. Sophie Hamada2,
  3. Mathieu Raux3,
  4. Matthieu Gay1,
  5. Jean Mantz4,
  6. Catherine Paugam Burtz4,5,
  7. Tobias Gauss4,
  8. Traumabase Group
    1. 1Emergency Medical Service Department, Beaujon University Hospital, Clichy, France
    2. 2Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris Sud, Université Paris Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France
    3. 3Department of Anaesthesiology and Intensive Care, Pitié Salpétrière University Hospital, Paris, France
    4. 4Department of Anaesthesiology and Critical Care, Beaujon University Hospital, Clichy, France
    5. 5Université Denis Diderot—Paris VII, Paris, France
    1. Correspondence to Dr François-Xavier Duchateau, Emergency Medical Service Department, Beaujon University Hospital, Hôpitaux Universitaires Paris Nord Val de Seine, Assistance Publique Hôpitaux de Paris, 100 bd du Général Leclerc, Clichy 92110, France; francois-xavier.duchateau{at}bjn.aphp.fr

    Abstract

    Background Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA.

    Methods This study is a retrospective database review of all patients from a multicentre prospective registry that experienced a TCA and had undergone successful cardiopulmonary resuscitation (CPR) prior their admission at the trauma centre. The primary end point was neurological outcome at 6 months among patients who survived to hospital discharge.

    Results 88 victims of TCA underwent successful CPR and were admitted to the hospital, 90% of whom were victims of blunt trauma. Of these 88 patients, 10 patients (11%; CI 95% 6% to 19%) survived to discharge: on discharge, 9 patients displayed a GCS of 15 and Cerebral Performance Categories (CPC) 1–2 and one patient had a GCS 7 and CPC of 3. Hypoxia was the most frequent cause of CA among survivors. 6-month follow-up was achieved for 9 patients of the 10 surviving patients. The 9 patients with a good outcome on hospital discharge had a CPC of 1 or 2 6 months post discharge. All returned to their premorbid family and social settings.

    Conclusions Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile.

    • cardiac arrest
    • pre-hospital
    • Trauma, majot trauma management

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    Footnotes

    • Collaborators The Traumabase Group: Jacques Duranteau (Service d'Anesthésie-Réanimation, Hôpital Bicêtre, Groupement Hôpitaux Universitaires Paris Sud, AP-HP, Kremlin Bicêtre, France); Bruno Riou (Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France); Bernard Vigué (Service d'Anesthésie-Réanimation, Hôpital Bicêtre, Groupement Hôpitaux Universitaires Paris Sud, AP-HP, Kremlin Bicêtre, Franc); Olivier Langeron (Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France), Anatole Harrois (Département d'Anesthésie Réanimation, Groupe Hospitalier Pitié-Salpêtrière Charles Foix, AP-HP, Paris, France).

    • Contributors F-XD and TG signed the study. F-XD, TG, SH, MR and MG collected the data. F-XD, SH and TG wrote the paper. MR, JM and CPB reviewed the manuscript.

    • Competing interests None declared.

    • Ethics approval IRB of Paris South Hospitals, Assistance Publique-Hôpitaux de Paris. This registry has institutional support and receives funding from the Regional Health Authority (Agence Régionale de Santé d'Ile de France, ARS). The institutional review board approved the study (Comité de Protection des Personnes—Paris Sud). Written information was provided to inform patients and/or their next of kin of the data collection, purpose of the study and 6-month follow-up phone interview.

    • Provenance and peer review Not commissioned; externally peer reviewed.

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