Abstract 363: Just Another Post-Arrest?: Predicting Outcomes in Traumatic Arrest and Hemorrhagic Shock

Abstract

Introduction: Traumatic cardiac arrest is a challenging presentation at trauma centers globally, with a high mortality and subsequent morbidity among survivors. For those who do obtain return of spontaneous circulation (ROSC), there is even less clarity with respect to how best to prognosticate outcomes. The previously derived and validated Pittsburgh Cardiac Arrest Categories (PCAC) have demonstrated value in predicting functional outcome and survival to hospital discharge in non-traumatic arrest. It is a 1 to 4 categorical score wherein a higher category is correlative to a worse clinical outcome. We hypothesized that the PCAC would be able to accurately predict outcomes in a trauma cohort. Methods: Utilizing the Pennsylvania Trauma Outcome System registry, 30 patients from 2018-2020 presented to a single, urban, tertiary trauma center with traumatic arrest. Demographics, vital statistics, injury patterns, and hospital course were abstracted and matched with subsequent PCAC scoring in accordance with previously published methods. Results: Population was predominantly male 16 (80%), black (75%) with a mean age 33 y (SD 13) . Penetrating trauma comprised 76% with average injury severity score of 38 (SD 22). Six (30%) were discharged alive with 5 requiring inpatient rehabilitation. Average length of hospital stay was 16 days (SD 18) with approximately 11 ventilator free days (SD 9). Average GFR at time of discharge was 44mg/dl (SD 31). The majority, 12 (57%), were PCAC 4 on arrival owing to predominant evidence of coma, 61%. By post-arrest day 1, there was a more even distribution between PCAC categories with category 2 (28%) and 3 (28%) each having 3 survivors and PCAC 4 (28%) having 2. By day 3, PCAC scores were less normally distributed with PCAC 1 having 6 survivors (42%) and PCAC 4 having 5 (35%). Day 1 and 3 categories continued to be driven principally be median Coma scores 0 (IQR: 0-8) but with regression of median SOFA cardiopulmonary scores 4 (IQR:0-6). SOFA Renal scores in survivors predictably increased from no injury to moderate dysfunction across this same period (IQR:1-4). Conclusion: PCAC scores in traumatic cardiac arrest patients who achieve ROSC do not predict multisystem organ failure but do predict neurologic outcome.