Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Hosomi, Sanae; Kitamura, Tetsuhisa; Sobue, Tomotaka; Zha, Ling; Kiyohara, Kosuke; Matsuyama, Tasuku; Oda, Jun

doi:10.3390/jcm11123564

Cited by 3 publications

(2 citation statements)

References 29 publications

(41 reference statements)

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“…No clear benefit for prehospital ROSC, in-hospital survival or short-term survival could be identified. An additional retrospective observational study explored outcomes amongst 2024 patients who sustained a blunt TCA following road traffic collision and were treated with adrenaline [18 ▪ ]. Similar to findings from the PARAMEDIC2 study [19], the investigators found a time dependent relationship on survival relating to the timing of adrenaline administration.…”

Section: Treatmentmentioning

confidence: 77%

Traumatic cardiac arrest

Lewis

Perkins

2023

Current Opinion in Critical Care

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Purpose of reviewThis review considers the latest evidence relating to the epidemiology and outcomes, treatment guidelines, diagnostic and therapeutic interventions in traumatic cardiac arrest.Recent findingsThere is variation in the incidence and outcomes of traumatic cardiac arrest which is influenced in part by case definitions. Irrespective of case definitions outcomes from traumatic cardiac arrest are typically worse than those seen from cardiac arrest due to medical causes but not so poor as to consider that treatment is futile. Clinical guidelines focus on the prompt treatment of reversible causes, although evidence that this improves outcomes is limited. Point of care ultrasound to assist with the identification of reversible causes should be limited to experienced operators where there is thought to be a high likelihood of a reversible cause being present. Care should be taken to minimize interruptions in chest compressions during scanning. There is little recent evidence to support specific therapeutic interventions. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta during traumatic cardiac arrest remains to be determined in on-going research.ConclusionTrauma related cardiac arrest differs from cardiac arrest due to medical causes. Whilst the core principles of treatment are similar, a higher priority is placed on identifying and treating reversible causes.

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Section: Treatmentmentioning

confidence: 77%

Traumatic cardiac arrest

Lewis

Perkins

2023

Current Opinion in Critical Care

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“…According to the American Heart Association, epinephrine is a recommended medication for treating cardiac arrest; [15] however, its therapeutic effects in TCA remain controversial. [10] In a prospective study, Hosomi et al [16] investigated the eff ect of epinephrine administration at different time points after traumatic out-of-hospital cardiac arrest. It included a total of 2,024 adult patients.…”

Section: Pre-and Intra-arrest Prognostic Factors Aff Ecting Survivalmentioning

confidence: 99%

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

Alremeithi,

K. Tran,

T. Quintana

et al. 2024

World Journal of Emergency Medicine

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BACKGROUND: Traumatic cardiac arrest (TCA) is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system. Although there have been advances in treatment modalities, survival rates for TCA patients remain low. This narrative literature review critically examines the indications and eff ectiveness of current therapeutic approaches in treating TCA. METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31, 2022. The search was refi ned by combining search terms, examining relevant study references, and restricting publications to the English language. Following the search, 943 articles were retrieved, and two independent reviewers conducted a screening process. RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm. There were conflicting results regarding other prognostic factors, such as witnessed arrest, bystander cardiopulmonary resuscitation (CPR), and the use of prehospital or in-hospital epinephrine. Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma. Resuscitative endovascular balloon occlusion of the aorta (REBOA) provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock. When implemented in the setting of aortic occlusion, emergency thoracotomy and REBOA resulted in comparable mortality rates. Veno-venous extracorporeal life support (V-V ECLS) and veno-arterial extracorporeal life support (V-A ECLS) are viable options for treating respiratory failure and cardiogenic shock, respectively. In the context of traumatic injuries, V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION: TCA remains a signifi cant challenge for emergency medical services due to its high morbidity and mortality rates. Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures. Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment effi cacy and ameliorate survival outcomes.

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Effect of a Targeted Ambulance Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest: A Metropolitan Citywide Intervention Study

Dong

Wang

et al. 2022

JCM

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The performance of ambulance crew affects the quality of pre-hospital treatment, which is vital to the survival for out-of-hospital cardiac arrest (OHCA) patients, yet remains suboptimal in China. In this retrospective analysis study, we aimed to examine the effect of a citywide quality improvement programme on provision of prehospital advanced life support (ALS) by emergency medical service (EMS) system. EMS-treated adult OHCA patients after the implementation of the programme (1 January 2021 to 30 June 2022) were compared with historical controls (1 June 2019 to 31 August 2020) in Suzhou. Multivariable logistic regression analysis and propensity score matching procedures were applied to compare the outcomes between two periods for total OHCA cases and subgroup of cases treated by fixed or non-fixed ambulance crews. A total of 1465 patients (pre-period/post-period: 610/855) were included. In the 1:1 matched analysis of 591 cases for each period, significant improvement (p < 0.05) was observed for the proportion of intravenous (IV) access (23.4% vs. 68.2%), advanced airway management (49.2% vs. 57.0%), and return of spontaneous circulation (ROSC) at handover (5.4% vs. 9.0%). The fixed ambulance crews performed better than non-fixed group in IV access and advanced airway management for both periods. There were significant increases in IV access (AOR 12.66, 95%CI 9.02–18.10, p < 0.001), advanced airway management (AOR 1.67, 95% CI 1.30–2.16, p < 0.001) and ROSC at handover (AOR 2.37, 95%CI 1.38–4.23, p = 0.002) after intervention in unfixed group, while no significant improvement was observed in fixed group except for IV access (AOR 7.65, 95%CI 9.02–18.10, p < 0.001). In conclusion, the quality improvement program was positively associated with the provision of prehospital ALS interventions and prehospital ROSC following OHCA. The fixed ambulance crews performed better in critical care provision and prehospital outcome, yet increased protocol adherence and targeted training could fill the underperformance of non-fixed crews efficaciously.

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Association between Timing of Epinephrine Administration and Outcomes of Traumatic Out-of-Hospital Cardiac Arrest following Traffic Collisions

Cited by 3 publications

References 29 publications

Traumatic cardiac arrest

Traumatic cardiac arrest

Approach to traumatic cardiac arrest in the emergency department: a narrative literature review for emergency providers

Effect of a Targeted Ambulance Treatment Quality Improvement Programme on Outcomes from Out-of-Hospital Cardiac Arrest: A Metropolitan Citywide Intervention Study

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