Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review

Abstract

IntroductionThis systematic review is focused on the in-hospital mortality and neurological outcome of survivors after prehospital resuscitation following trauma. Data were analyzed for adults/pediatric patients and for blunt/penetrating trauma.MethodsA systematic review was performed using the data available in Ovid Medline. 476 articles from 1/1964 - 5/2011 were identified by two independent investigators and 47 studies fulfilled the requirements (admission to hospital after prehospital resuscitation following trauma). Neurological outcome was evaluated using the Glasgow outcome scale.Results34 studies/5391 patients with a potentially mixed population (no information was found in most studies if and how many children were included) and 13 paediatric studies/1243 children (age ≤ 18 years) were investigated. The overall mortality was 92.8% (mixed population: 238 survivors, lethality 96.7%; paediatric group: 237 survivors, lethality 86.4% = p < 0.001).Penetrating trauma was found in 19 studies/1891 patients in the mixed population (69 survivors, lethality: 96.4%) and in 3 pediatric studies/91 children (2 survivors lethality 97.8%).44.3% of the survivors in the mixed population and 38.3% in the group of children had a good neurological recovery. A moderate disability could be evaluated in 13.1% in the mixed population and in 12.8% in children. A severe disability was found in 29.5% of the survivors in the mixed patients and in 38.3% in the group of children. A persistent vegetative state was the neurological status in 9.8% in the mixed population and in 10.6% in children.For each year prior to 2010, the estimated log-odds for survival decreased by 0.022 (95%-CI: [0.038;0.006]). When jointly analyzing the studies on adults and children, the proportion of survivors for children is estimated to be 17.8% (95%-CI: [15.1%;20.8%]). The difference of the paediatric compared to the adult proportion is significant (p < 0.001).ConclusionsChildren have a higher chance of survival after resuscitation of an out-of-hospital traumatic cardiac arrest compared to adults but tend to have a poorer neurological outcome at discharge.

Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting

“…The overall survival rate in our study population was 3.4% (11/328), which was similar to most previous studies of 0%–22% (mean, 4.4%) 2. Prior studies have shown that EMS personnel were able to accurately determine TCPA in the field and that violation of the TOR guidelines for TCPA would result in unnecessary resuscitation and hospital transport, potentially leaving the victim in a neurologically devastated state 13 14…”

Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors

“…Survival from cases of traumatic out-of-hospital cardiac arrest (OHCA) is generally reported to be low, with a recent systematic review reporting an overall survival of 3.3% 1. Despite this, there has been an emerging interest in traumatic OHCA.…”

Prehospital traumatic cardiac arrest

“…Survival rates from traumatic arrest have been poor, with approximately 2% of patients surviving to hospital discharge(1). However, more contemporary studies from diverse settings and locations including military experience(2), Australia(3), England(4), the United States(5), Spain(6), and a recent systematic review(7) report survival rates between 5-8%.…”