Evaluation of outcomes after EMS-witnessed traumatic out-of-hospital cardiac arrest caused by traffic collisions

Kitano, Shinnosuke; Fujimoto, Kenji; Suzuki, Kenji; Harada, Satoshi; Narikawa, Kenji; Yamada, Marina; Nakazawa, Mayumi; Ogawa, Satoo

doi:10.1016/j.resuscitation.2021.12.023

Cited by 4 publications

(4 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…During the prehospital TCA phase, patients who experienced TCA in the EMS phase had the most favorable outcome when the TCA was witnessed after the EMS team arrived and before the arrival of the HEMS team. This finding is consistent with that reported by Kitano et al [ 19 ]. The most severe cases of prehospital TCA occurred in the HEMS phase, consistent with our clinical experience.…”

Section: Discussionsupporting

confidence: 94%

See 1 more Smart Citation

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis

Nagasawa,

Omori,

Muramatsu

et al. 2023

Int J Emerg Med

View full text Add to dashboard Cite

Background Traumatic cardiac arrest (TCA) is associated with poor outcomes. Helicopter emergency medical services (HEMSs) are often used to transport critically ill patients to hospitals. However, the role of HEMS in the treatment of TCA remains unclear. Therefore, in this study, we aimed to determine the current status of patients with prehospital TCA managed by HEMS personnel in Japan and compare the outcomes of patients who experienced TCA before and after the arrival of HEMS. Methods The Japanese Society for Aeromedical Services registry data of patients managed by HEMS personnel from April 2015 to March 2020 were analyzed in this retrospective cohort study. HEMS arrival and physicians’ interventions at the scene were the variables of interest. The survival rate and neurological outcomes at 28 days after injury were analyzed. Results Of the 55 299 registered patients, 722 who experienced prehospital TCA were included in the analysis. The distribution of first-witnessed TCA was as follows: pre-emergency medical service (EMS) arrival (n = 426/722, 60.3%), after EMS arrival (n = 113/722, 16.0%), and after HEMS arrival (n = 168/722, 23.8%). The 28-day survival rate was 6.2% (n = 44/706), with a cerebral performance category of 1 or 2 in 18 patients. However, patients who experienced TCA after receiving interventions provided by physicians before HEMS arrival had the worst outcomes, with only 0.6% of them surviving with favorable neurological outcomes. Multivariable analysis revealed that securing the intravenous route by the EMS team (adjusted odds ratio: 2.43, 95% confidence interval [CI]: 1.11–5.30) and tranexamic acid infusion by the HEMS team (adjusted odds ratio: 2.78, 95% CI: 1.16–6.64) may have increased the return of spontaneous circulation (ROSC) rate. Conclusions The results of our study were similar to those reported in previous studies with regards to the use of HEMS in Japan for transporting patients with TCA. Our findings suggest that in patients with severe trauma, cardiac arrest after initiation of HEMS, the highest level of prehospital medical intervention, may be associated with an inferior prognosis. Tracheal intubation and administration of tranexamic acid by the EMS team may increase the rate of ROSC in TCA.

show abstract

Section: Discussionsupporting

confidence: 94%

“…This might be related to the better rate of ROSC in the pre-EMS and EMS phases. Although epinephrine is a drug that the EMS crew can administer to patients with cardiac arrest, previous studies [ 14 , 15 , 19 ] and our study suggest that it may not improve the outcomes of patients with trauma.…”

Section: Discussioncontrasting

confidence: 63%

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis

Nagasawa,

Omori,

Muramatsu

et al. 2023

Int J Emerg Med

View full text Add to dashboard Cite

show abstract

“…The 1-month survival rate of this group was reported to be 10.9%, and the rate of return of spontaneous circulation was 14.4%. Furthermore, in that study, the median time from injury to cardiac arrest was 18 min 16 . As early intervention at the scene is necessary for injured patients at high risk of progressing to cardiac arrest during transport, it is important to promptly determine upon arrival at the scene which injured patients are most likely to progress to cardiac arrest.…”

Section: Discussionmentioning

confidence: 72%

Development of a Machine Learning Model to Predict Cardiac Arrest during Transport of Trauma Patients

et al. 2023

View full text Add to dashboard Cite

Background: Trauma is a serious medical and economic problem worldwide, and patients with trauma injuries have a poor survival rate following cardiac arrest. This study aimed to create a prediction model specific to prehospital trauma care and to achieve greater accuracy with techniques of machine learning.Methods: This retrospective observational study investigated data of patients who had blunt trauma injuries due to traffic accident and fall trauma from January 1, 2018, to December 31, 2019, using the National Emergency Medical Services Information System, which stores emergency medical service activity records nationwide in the United States. Random forest was used to develop a machine learning model. Results:Per the prediction model, the area under the curve of the predictive model was 0.95 and negative predictive value was 0.99. The feature importance of the predictive model was the highest for the AVPU scale (an acronym from "Alert, Verbal, Pain, Unresponsive"), followed by oxygen saturation (SpO2). Among patients who were progressing to cardiac arrest, the cutoff value was 89% for SpO2 in unalert patients.Conclusions: Patients whose conditions did not progress to cardiac arrest could be identified with high accuracy by machine learning model techniques.

show abstract

“…Other factors associated with better outcomes included younger age [7], female sex [7], lower injury severity [4 ▪ ,7], extremity injury [7], arrest witnessed by a clinician [3 ▪ ,7,8], bystander cardiopulmonary resuscitation (CPR) [3 ▪ ], an initially shockable rhythm [2,3 ▪ ,4 ▪ ,6 ▪▪ ,9], advanced airway management [2], intravenous access [2], shorter transfer time [10 ▪ ], reactive pupils [4 ▪ ,9], and receiving emergency surgery [7].…”

Section: Epidemiology and Outcomesmentioning

confidence: 99%

Traumatic cardiac arrest

Lewis

Perkins

2023

Current Opinion in Critical Care

View full text Add to dashboard Cite

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.

show abstract

Evaluation of outcomes after EMS-witnessed traumatic out-of-hospital cardiac arrest caused by traffic collisions

Cited by 4 publications

References 19 publications

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis

Outcomes of prehospital traumatic cardiac arrest managed by helicopter emergency medical service personnel in Japan: a registry data analysis

Development of a Machine Learning Model to Predict Cardiac Arrest during Transport of Trauma Patients

Traumatic cardiac arrest

Contact Info

Product

Resources

About