Abstract 412: Chance of Survival Decreases Within 10 Minutes of Transport in Trauma Patients Receiving Preospital Cardiopulmonary Resuscitation

Abstract

Introduction: Patients with traumatic cardiac arrest (TCA) are known to have poor prognoses. The joint committee of the National Association of EMS Physicians and the American College of Surgeons Committee on Trauma proposes stopping cardiopulmonary resuscitation (CPR) more than 15 minutes after TCA. However, with advances in resuscitation strategies, recent published data show improved outcomes. Data supporting TCA’s critical time limit is lacking. Hypothesis: We studied whether longer transport time is associated with poor outcomes in TCA. Methods: Retrospective review from the Japan Trauma Data Bank (2004-2017). Inclusion criteria were patients age ≥ 16 with at least one Abbreviated Injury Scale score (AIS) ≥ 3 trauma and CPR performed during the transport. Exclusion criteria were patients with burns, AIS score = 6 in any region, and missing survival data. Primary outcome was the association between transport time and survival in patients with no vital signs at arrival. For secondary outcomes, survival between penetrating injury/blunt injury and no vital signs (Revised Trauma Score [RTS] = 0)/any vital sign (RTS > 0) were compared. For the primary outcome, probability of survival was drawn with risk ratio (reference 15 min) according to transport time. Fisher’s exact test was used to compare secondary outcomes. Results: 5,334 patients were included. Patient characteristics were age (53 ± 21 years), sex (67% male), Injury Severity Score (31 ± 13), blunt trauma (95%), and transportation time (16 ± 15 min). Overall survival rate was 4.5%, survival rate in patients without vital sign at arrival was 1.2%. Survival rate decreased within 10 min ( Figure ). Penetrating trauma increased the chance of survival compared with blunt trauma (7.7% vs. 4.1%, OR 1.9, p = 0.006). Chance of survival increased when the patient had any vital sign at arrival (28% vs. 1.2%, OR 33, p < 0.001). Conclusions: Longer transport time was associated with worse outcome, supporting the current guideline.