Algorithm to Improve Resuscitation Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest.

Hsin-Min Lee,Kuo-Tai Chen,Chien-Chin Hsu,Chia-Ti Wang

doi:10.7759/cureus.23194

Abstract

Background: This study proposed an algorithm to improve resuscitation outcomes in the emergency department (ED) for patients with traumatic out-of-hospital cardiac arrest (TOHCA). We also performed a retrospective chart review of patient outcomes before and after implementing the algorithm and sought to define factors that might influence patient outcomes.Methods: In September 2018, we implemented an algorithm for patients with TOHCA. This algorithm rapidly identifies possible causes of TOHCA and recommends appropriate interventions. We retrospectively reviewed the outcomes of all patients with TOHCA during a five-year period (comprising periods before and after the algorithm) and compared the results before and after the implementation of the algorithm.Results: After this algorithm was implemented, the use of the ED interventions of blood transfusion, placement of a large-bore central venous catheter, and thoracostomy increased significantly. The rate of return of spontaneous circulation (ROSC) also increased (before vs. after: ROSC: 23.6% vs. 41.5%, P = 0.035). Regarding hospital admission and survival to hospital discharge, we observed the trend of increment (hospital admission: 18.2% vs. 24.6%, P = 0.394; survival to hospital discharge: 0.0% vs. 4.6%, P = 0.107). Admitted patients exhibited a higher end-tidal CO2 level during resuscitation than nonadmitted patients [admitted vs. nonadmitted: 41.5 (33.3-52.0) vs. 12.0 (7.5-18.8), P = 0.001].Conclusion: Our algorithm prioritizes the three major treatable causes of TOHCA: impedance of venous return, hypovolemia, and hypoxia. We found that rate of ROSC increased with the increasing implementation of the ED interventions recommended by the algorithm.

Highlights

Advanced Cardiovascular Life Support is a clinical algorithm that guides the acute treatment of patients with cardiac arrest
If the patient develops a return of spontaneous circulation (ROSC), the resuscitation team will seek out any reversible causes of cardiac arrest and treat them if discovered
We implemented an algorithm to improve the outcome of patients with traumatic out-of-hospital cardiac arrest (TOHCA)

Summary

Introduction

Advanced Cardiovascular Life Support is a clinical algorithm that guides the acute treatment of patients with cardiac arrest. The resuscitation of a patient with cardiac arrest usually starts from standard Advanced Cardiovascular Life Support, which includes defibrillation for a shockable rhythm, continuous and uninterrupted chest compressions, emergent tracheal intubation with artificial ventilation, and injections of intravenous adrenaline every three to five minutes. If the patient develops a return of spontaneous circulation (ROSC), the resuscitation team will seek out any reversible causes of cardiac arrest and treat them if discovered. This approach is reasonable for patients with nontraumatic out-of-hospital cardiac arrest because lethal arrhythmia is the major reversible cause of cardiac arrest [1,2]. TOHCA has a different aetiology than nontraumatic out-of-hospital cardiac arrest [1-3]; using Advanced Cardiovascular Life Support may delay the timely treatment of reversible causes of TOHCA. We performed a retrospective chart review of patient outcomes before and after implementing the algorithm and sought to define factors that might influence patient outcomes

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