Traumatic out-of-hospital cardiac arrests in Melbourne, Australia

Deasy, Conor, Bray, Janet, Smith, Karen, Harriss, Linton, Morrison, Chris, Bernard, Stephen, and Cameron, Peter (2012) Traumatic out-of-hospital cardiac arrests in Melbourne, Australia. Resuscitation, 83 (4). pp. 465-470.

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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.

Item ID: 40502
Item Type: Article (Refereed Research - C1)
Keywords: trauma; out-of-hospital cardiac arrest; emergency medical service; EMS; resuscitation
ISSN: 1873-1570
Date Deposited: 16 Sep 2015 03:46
FoR Codes: 11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110305 Emergency Medicine @ 34%
11 MEDICAL AND HEALTH SCIENCES > 1117 Public Health and Health Services > 111706 Epidemiology @ 33%
11 MEDICAL AND HEALTH SCIENCES > 1103 Clinical Sciences > 110310 Intensive Care @ 33%
SEO Codes: 92 HEALTH > 9202 Health and Support Services > 920204 Evaluation of Health Outcomes @ 40%
92 HEALTH > 9204 Public Health (excl. Specific Population Health) > 920409 Injury Control @ 40%
92 HEALTH > 9201 Clinical Health (Organs, Diseases and Abnormal Conditions) > 920103 Cardiovascular System and Diseases @ 20%
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