Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: a nationwide observational study

Abstract

Objective To evaluate the prognostic factors associated with the sustained return of spontaneous circulation (ROSC) and survival to hospital discharge in traumatic out-of-hospital cardiac arrest (TOHCA) patients without prehospital ROSC. Methods We analyzed Korean nationwide data from the Out-of-Hospital Cardiac Arrest Surveillance, and included adult TOHCA patients without prehospital ROSC from January 2012 to December 2016. The primary outcome was sustained ROSC (> 20 minutes). The secondary outcome was survival to discharge. Multivariate analysis was performed to investigate factors associated with the outcomes of TOHCA patients. Results Among 142,905 cases of OHCA, 8,326 TOHCA patients were investigated. In multivariate analysis, male sex (odds ratio [OR], 1.326; 95% confidence interval [CI], 1.103-1.594; P = 0.003), and an initial shockable rhythm (OR, 1.956; 95% CI, 1.113-3.439; P = 0.020) were significantly associated with sustained ROSC. Compared with traffic crash, collision (OR, 1.448; 95% CI, 1.086-1.930; P = 0.012) was associated with sustained ROSC. Fall (OR, 0.723; 95% CI, 0.589-0.888; P = 0.002) was inversely associated with sustained ROSC. Male sex (OR, 1.457; 95% CI, 1.026-2.069; P = 0.035) and an initial shockable rhythm (OR, 4.724; 95% CI, 2.451-9.106; P < 0.001) were significantly associated with survival to discharge. Metropolitan city (OR, 0.728; 95% CI, 0.541-0.980; P = 0.037) was inversely associated with survival to discharge. Compared with traffic crash, collision (OR, 1.745; 95% CI, 1.125-2.708; P = 0.013) was associated with survival to discharge. Conclusion Male sex, an initial shockable rhythm, and collision could be favorable factors for sustained ROSC, whereas fall could be an unfavorable factor. Male sex, non-metropolitan city, an initial shockable rhythm, and collision could be favorable factors in survival to discharge.

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

“…Fifty-six articles were excluded for various reasons (Fig. 1 ), resulting in 36 articles being included [ 1 – 3 , 5 , 6 , 16 – 47 ]. All studies scored 6 or 7 points on the Newcastle–Ottawa Quality Assessment Scale and therefore no study was excluded for quality reasons (Table 1 ).…”

“…Most included studies ( n = 21) were published between 2016 and 2019 [ 27 – 47 ], and most of the 36 primary studies were carried out in either Europe ( n = 14) [ 2 , 3 , 6 , 19 – 21 , 28 , 32 , 33 , 35 , 36 , 40 , 44 , 46 ] or Asia ( n = 13) [ 22 , 25 , 26 , 30 , 31 , 34 , 37 – 39 , 41 , 43 , 45 , 47 ]. Almost all included studies were retrospective cohort studies ( n = 32) [ 1 – 3 , 16 – 18 , 20 – 38 , 40 – 44 , 46 , 47 ] and included both penetrating and blunt trauma cases ( n = 30) [ 1 – 3 , 16 , 17 , 19 – 21 , 23 – 25 , 27 , 28 , 30 – 36 , 40 – 47 ]. More detailed characteristics of the included primary studies are shown in Table 2 .…”

“…To investigate TCA mortality for different database registry types, pooled mortality rates were calculated separately for 27 studies including prehospital deaths [ 1 , 3 , 6 , 17 , 21 , 22 , 24 – 27 , 29 – 32 , 34 – 41 , 43 – 47 ] and for nine studies excluding prehospital deaths (Fig. 3 ) [ 2 , 16 , 18 – 20 , 23 , 28 , 33 , 42 ].…”

Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study

“…As shown in our study, ROSC before arrival at the ED is a predictor for survival, and longer transport times did not reduce survival-to-discharge when ROSC was observed, indicating continued efforts should be devoted to these cases. Other studies have shown that an [14][15][16][17]. Pulseless electrical activity (PEA) or preserved cardiac wall motion observed by ultrasound examination may also be predictive of survival and can be easily performed in the ED [18].…”

Derivation and validation of the CANP scoring model for predicting the neurological outcome in post-cardiac arrest patients

“…Neurological outcomes of patients resuscitated from CA are associated with various individual-related factors, such as age, comorbidities, and CA event circumstances, including unwitnessed arrest, cardiac rhythm and time to ROSC at the initial assessment. 14 These factors together with clinical investigations and laboratory/imaging tests at hospital admission might already provide information about an individual’s fate in terms of unfavorable neurological outcomes and mortality. 15 Previous studies have focused on early neurological outcome indicators of comatose post-CA survivors.…”