Article Text

PDF
Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors
  1. Ben Beck1,
  2. Janet E Bray1,2,3,
  3. Peter Cameron1,3,
  4. Lahn Straney1,
  5. Emily Andrew1,4,
  6. Stephen Bernard1,4,6,
  7. Karen Smith1,4,5
  1. 1Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Melbourne, Victoria, Australia
  2. 2Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Perth, Western Australia, Australia
  3. 3Emergency and Trauma Centre, The Alfred Hospital, Melbourne, Victoria, Australia
  4. 4Centre for Research and Evaluation, Ambulance Victoria, Melbourne, Victoria, Australia
  5. 5Department of Community Emergency Health and Paramedic Practice, Monash University, Melbourne, Victoria, Australia
  6. 6Intensive Care Unit, The Alfred Hospital, Melbourne, Victoria, Australia
  1. Correspondence to Dr Ben Beck, Department of Epidemiology and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, VIC 3004, Australia; ben.beck{at}monash.edu

Abstract

Background Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA.

Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning.

Results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24%) and 95 patients (14%) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95% CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95% CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95% CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95% CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95% CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95% CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95% CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital.

Conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.

  • Cardiac Arrest
  • Trauma
  • Emergency Ambulance Systems

Statistics from Altmetric.com

Footnotes

  • Twitter @DrBenBeck

  • Contributors BB, JB, PC, LS, EA, SB, KS contributed to the design and planning of the study. BB and LS performed the analysis. BB, JB, PC, LS, EA, SB, KS drafted the manuscript.

  • Funding BB, JB and LS receive salary support by the National Health and Medical Research Council (NHRMC) Australian Resuscitation Outcomes Consortium (Aus-ROC) Centre of Research Excellence #1029983 https://www.ausroc.org.au/. JB is supported by a co-funded NHMRC/National Heart Foundation (NHF) Fellowship (#1069985). Peter Cameron was supported by a NHMRC Practitioner Fellowship (#545926).

  • Competing interests None declared.

  • Ethics approval Monash University Human Research Ethics Committee.

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

Request permissions

If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.