Surviving traumatic cardiac arrest: Identification of factors associated with survival

Khalifa, Andrew; Avraham, Jacob B.; Kramer, Kristina; Bajani, Francesco; Fu, Chih-Yuan; Pires-Menard, Alexandra; Kaminsky, Matthew; Bokhari, Faran

doi:10.1016/j.ajem.2021.01.020

Cited by 11 publications

(14 citation statements)

References 21 publications

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“…This has implications for the management of patients who arrive at the ED with traumatic cardiac arrest. Majority of these patients are blunt trauma patients who had road traffic collisions or fall from height having a low survival rate [ 39 ]. Additional file 2 : Table S2 summarizes the proposed recommendations to improve our trauma system.…”

Section: Discussionmentioning

confidence: 99%

Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study

2023

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Aim To study the epidemiology and pattern of trauma-related deaths of hospitalized patients in Abu Dhabi Emirate, United Arab Emirates, in order to improve trauma management and injury prevention. Methods The Abu Dhabi Trauma Registry prospectively collects data of all hospitalized trauma patients from seven major trauma centres in Abu Dhabi Emirate. We studied all patients who died on arrival or after admission to these hospitals from January 2014 to December 2019. Results There were 453 deaths constituting 13.5% of all trauma deaths in the Abu Dhabi Emirate. The median (IQR) age of the patients was 33 (25–45) years, and 82% were males. 85% of the deaths occurred in the emergency department (ED) and the intensive care unit (ICU). Motor vehicle collision (63.8%) was the leading cause of death. 45.5% of the patients had head injury. Two of the seven hospitals admitted around 50% of all patients but accounted for only 25.8% of the total deaths (p < 0.001). Those who died in the ward (7%) were significantly older, median (IQR) age: of 65.5 (31.75–82.25) years, (p < 0.001), 34.4% of them were females (p = 0.09). The median (IQR) GCS of those who died in the ward was 15 (5.75–15) compared with 3 (3–3) for those who died in ED and ICU (P < 0.001). Conclusions Death from trauma predominantly affects young males with motor traffic collision as the leading cause. Over 85% of in-hospital deaths occur in the ICU and ED, mainly from head injuries. Injury prevention of traffic collisions through enforcement of law and improved hospital care in the ED and ICU will reduce trauma death.

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Section: Discussionmentioning

confidence: 99%

Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study

2023

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“…Treatment of TCA historically results in very low survival rates, [4][5][6][7] and current evidence-based guidelines focus on prehospital management only. 8 Even marginal increases in survival would be an improvement, as current estimates suggest that over one hundred resuscitations must be attempted to save one patient.…”

Section: Introductionmentioning

confidence: 99%

“…7 Resuscitation proved least successful in cases of hypovolemia and was more likely to be successful in cases where less than 15 min of CPR were needed, and where appropriate interventions on correctable causes of arrest were identified and completed quickly. 5 In 2013, the American Association for the Surgery of Trauma (AAST) published criteria to commence, withhold, or terminate resuscitation attempts 8 ; however, the application of ACLS in TCA continues to be variable among practicing physicians. [10][11][12][13] Recent studies suggest that physician involvement in early care may affect increased success, 13 but little data exist to demonstrate how many physicians utilize ACLS in the treatment of TCA.…”

Section: Introductionmentioning

confidence: 99%

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A National Survey Assessing the Variability in the Management of Traumatic Cardiac Arrest

Roche

Quinn

Mannino

et al. 2023

The American Surgeon™

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Background Resuscitation of traumatic cardiac arrest (TCA) is variable, with approaches that overlap Advanced Trauma Life Support (ATLS) and Advanced Cardiac Life Support (ACLS) algorithms. There is no standard algorithm for TCA, with some withholding ACLS protocols given abysmal outcomes. This study aims to assess surgeon practices and attitudes toward resuscitation practices in TCA. Materials and Methods A 16-question web-based survey was distributed to the membership of a national trauma association. Respondent demographics and management of TCA were analyzed. Chi-squared tests determined statistical significance. Open-ended responses were coded and analyzed inductively. Results Two hundred and three surveys were completed. 73.4% of respondents reported utilizing ACLS, while 26.6% reported they never utilized ACLS. A statistically significant difference in the performance of ACLS was found based on number of years in practice ( P = .025) and the state of practice ( P = .006). There was no significant difference in self-reported survival rates or legal, ethical, or interpersonal conflicts. Qualitative data highlighted themes of interpersonal conflict and futility. Discussion This study shows that one-quarter of respondents never utilize ACLS in TCA. Of those that utilize ACLS, there was variability in the technique, indication, and duration of resuscitation. Despite significant variability in technique, there appears to be similar survival rates and incidence of conflict. The association between years in practice and ACLS use suggests this may represent an emerging change in practice. The low response rate limits generalizability; however, there is significant variability in practice, highlighting a need for evidence-based guidelines.

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“…Closed abdominal injury with severe multiple traumas is characterized by complex and hidden conditions, and most patients are accompanied by injuries to the brain, chest, and limbs (1). The prognosis of closed abdominal injury depends on the presence or absence of visceral injury, which is characterized by persistent vomiting, nausea, abdominal pain, internal bleeding, and peritoneal irritation in terms of clinical symptoms (2). For patients with closed abdominal injuries accompanied by severe multiple injuries, besides abdominal injuries, fractures, brain injuries, etc., are also present (3).…”

Section: Introductionmentioning

confidence: 99%

Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients With Closed Abdominal Injury Complicated With Severe Multiple Abdominal Injuries

et al. 2021

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ObjectiveWe aimed to evaluate the diagnostic value of soluble interleukin-2 receptor (sIL-2R), tumor necrosis factor-α (TNF-α), procalcitonin (PCT), and combined detection for sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries.Patients and MethodsOne hundred forty patients with closed abdominal injury complicated with severe multiple abdominal injuries who were diagnosed and treated from 2015 to 2020 were divided into a sepsis group (n = 70) and an infection group (n = 70).ResultsThe levels of sIL-2R, TNF-α, and PCT in the sepsis group were higher than those in the infection group (p < 0.05). The receiver operating characteristic (ROC) curve showed that the areas under the ROC curve (AUCs) of sIL-2R, TNF-α, PCT and sIL-2R+TNF-a+PCT were 0.827, 0.781, 0.821, and 0.846, respectively, which were higher than those of white blood cells (WBC, 0.712), C-reactive protein (CRP, 0.766), serum amyloid A (SAA, 0.666), and IL-6 (0.735). The AUC of the three combined tests was higher than that of TNF-α, and the difference was statistically significant (p < 0.05). There was no significant difference in the AUCs of sIL-2R and TNF-α, sIL-2R and PCT, TNF-α and PCT, the three combined tests and sIL-2R, and the three combined tests and PCT (p > 0.05). When the median was used as the cut point, the corrected sIL-2R, TNF-α, and PCT of the high-level group were not better than those of the low-level group (p > 0.05). When the four groups were classified by using quantile as the cut point, the OR risk values of high levels of TNF-α and PCT (Q4) and the low level of PCT (Q1) after correction were 7.991 and 21.76, respectively, with statistical significance (p < 0.05).ConclusionsThe detection of sIL-2R, TNF-α, and PCT has good value in the diagnosis of sepsis infection in patients with closed abdominal injury complicated with severe multiple abdominal injuries. The high concentrations of PCT and TNF-α can be used as predictors of the risk of septic infection.

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Surviving traumatic cardiac arrest: Identification of factors associated with survival

Cited by 11 publications

References 21 publications

Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study

Trauma deaths of hospitalized patients in Abu Dhabi Emirate: a retrospective descriptive study

A National Survey Assessing the Variability in the Management of Traumatic Cardiac Arrest

Diagnostic Value of sIL-2R, TNF-α and PCT for Sepsis Infection in Patients With Closed Abdominal Injury Complicated With Severe Multiple Abdominal Injuries

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