Traumatic cardiac arrest – a nationwide Danish study

Wolthers, Signe Amalie; Jensen, Theo Walther; Breindahl, Niklas; Milling, Louise; Blomberg, Stig Nikolaj; Andersen, Lars Bredevang; Mikkelsen, Søren; Torp‐Pedersen, Christian; Christensen, Helle Collatz

doi:10.1186/s12873-023-00839-1

Cited by 6 publications

(3 citation statements)

References 38 publications

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“…Without data supporting an alternative strategy, adopting the Advanced Life Support Task Force recommendations to restore ventilation and circulation seems reasonable [ 38 ]. This study found an association between 30-day mortality and intraosseous cannulation and the use of an automated chest compression device, suggesting confounding by indication through disease severity bias, as patients with severe drowning may be more likely to receive these interventions, as observed in other studies [ 39 ]. Our results could be interpreted likewise.…”

Section: Discussionsupporting

confidence: 64%

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up

Breindahl,

Wolthers,

Møller

et al. 2024

Scand J Trauma Resusc Emerg Med

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Background Improving oxygenation and ventilation in drowning patients early in the field is critical and may be lifesaving. The critical care interventions performed by physicians in drowning management are poorly described. The aim was to describe patient characteristics and critical care interventions with 30-day mortality as the primary outcome in drowning patients treated by the Danish Air Ambulance. Methods This retrospective cohort study with 30-day follow-up identified drowning patients treated by the Danish Air Ambulance from January 1, 2016, through December 31, 2021. Drowning patients were identified using a text-search algorithm (Danish Drowning Formula) followed by manual review and validation. Operational and medical data were extracted from the Danish Air Ambulance database. Descriptive analyses were performed comparing non-fatal and fatal drowning incidents with 30-day mortality as the primary outcome. Results Of 16,841 dispatches resulting in a patient encounter in the six years, the Danish Drowning Formula identified 138 potential drowning patients. After manual validation, 98 drowning patients were included in the analyses, and 82 completed 30-day follow-up. The prehospital and 30-day mortality rates were 33% and 67%, respectively. The National Advisory Committee for Aeronautics severity scores from 4 to 7, indicating a critical emergency, were observed in 90% of the total population. They were significantly higher in the fatal versus non-fatal group (p < 0.01). At least one critical care intervention was performed in 68% of all drowning patients, with endotracheal intubation (60%), use of an automated chest compression device (39%), and intraosseous cannulation (38%) as the most frequently performed interventions. More interventions were generally performed in the fatal group (p = 0.01), including intraosseous cannulation and automated chest compressions. Conclusions The Danish Air Ambulance rarely treated drowning patients, but those treated were severely ill, with a 30-day mortality rate of 67% and frequently required critical care interventions. The most frequent interventions were endotracheal intubation, automated chest compressions, and intraosseous cannulation.

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Section: Discussionsupporting

confidence: 64%

Characteristics and critical care interventions in drowning patients treated by the Danish Air Ambulance from 2016 to 2021: a nationwide registry-based study with 30-day follow-up

Breindahl,

Wolthers,

Møller

et al. 2024

Scand J Trauma Resusc Emerg Med

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“…All patients were critically injured, with a median injury severity score of 41. Twenty-three percent of the patients were in cardiac arrest at some point, demonstrating the severity of the situation and realistically poor prognosis, as cardiac arrest following trauma has devastatingly low survival [ 9 ]. The REBOA group had in general lower systolic BP than the SC group making it questionable whether these patients may have survived, regardless of advanced resuscitation.…”

Section: Main Textmentioning

confidence: 99%

The end of balloons? Our take on the UK-REBOA trial

Brede,

Rehn

2023

Scand J Trauma Resusc Emerg Med

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Background Resuscitative endovascular balloon occlusion of the aorta (REBOA) is increasingly used. The recently published UK-REBOA trial aimed to investigate patients suffering haemorrhagic shock and randomized to standard care alone or REBOA as adjunct to standard care and concludes that REBOA may increase the mortality. Main body In this commentary we try to balance the discussion on use of REBOA and address limitations in the UK-REBOA trial that may have influenced the outcome of the study. Conclusion The situation is complex, and the patients are in extremis. In summary, we do not think this is the end of balloons.

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“…The recent advancements in pre-hospital care, including improved trauma systems, expedited transport, and refined triage protocols, contribute significantly to enhancing the survival rates for TCA patients [3].…”

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confidence: 99%