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

被引:92
作者
Evans, Christopher C. D. [1 ]
Petersen, Ashley [2 ]
Meier, Eric N. [2 ]
Buick, Jason E. [3 ]
Schreiber, Martin [4 ]
Kannas, Delores
Austin, Michael A. [5 ]
机构
[1] Queens Univ, Dept Emergency Med, Kingston, ON, Canada
[2] Univ Washington, Dept Biostat, Seattle, WA 98195 USA
[3] Univ Toronto, St Michaels Hosp, Li Ka Shing Knowledge Inst, Rescu, Toronto, ON, Canada
[4] Oregon Hlth & Sci Univ, Dept Surg, Portland, OR 97201 USA
[5] Univ Ottawa, Dept Emergency Med, Ottawa, ON, Canada
基金
加拿大健康研究院;
关键词
Cardiac arrest; prehospital; emergency medical services; resuscitation; intubation; EMERGENCY-DEPARTMENT THORACOTOMY; CARDIOPULMONARY ARREST; MEDICAL-SERVICE; ASSOCIATION; SURVIVAL; EPIDEMIOLOGY; IMPROVEMENT; PERFORMANCE; PREDICTORS; ALGORITHM;
D O I
10.1097/TA.0000000000001070
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
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. Copyright (C) 2016 Wolters Kluwer Health, Inc. All rights reserved.
引用
收藏
页码:285 / 293
页数:9
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