Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest

Chien-Hsin Lu,Chih-Hao Lin,Pin-Hui Fang

doi:10.1186/s13049-019-0679-2

Abstract

BackgroundResuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and thus may enhance survival and neurologic outcomes of non-traumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA.MethodsA retrospective cohort study was conducted using an Utstein-style population database with data from January 1, 2014, to December 31, 2016, in Tainan City, Taiwan. Voice recordings of emergency calls were retrospectively retrieved and reviewed. The primary outcome was an achievement of sustained (≥2 h) return of spontaneous circulation (ROSC); the secondary outcomes were prehospital ROSC, ever ROSC, survival at discharge and favourable neurologic status at discharge. Statistical significance was set at a p-value of less than 0.05.ResultsA total of 4526 OHCA cases were enrolled. Traumatic OHCA cases (n = 560, 12.4%), compared to medical OHCA cases (n = 3966, 87.6%), were less likely to have bystander CPR (10.7% vs. 31.7%, p < 0.001) and initially shockable rhythms (7.1% vs. 12.5%, p < 0.001). Regarding DA-CPR performance, traumatic OHCA cases were less likely to have dispatcher recognition of cardiac arrest (6.3% vs. 42.0%, p < 0.001), dispatcher initiation of bystander CPR (5.4% vs. 37.6%, p < 0.001), or any dispatcher delivery of CPR instructions (2.7% vs. 20.3%, p < 0.001). Stepwise logistic regression analysis showed that witnessed cardiac arrests (aOR 1.70, 95% CI 1.10–2.62; p = 0.017) and transportation to level 1 centers (aOR 1.99, 95% CI 1.27–3.13; p = 0.003) were significantly associated with achievement of sustained ROSC in traumatic OHCA cases, while DA-CPR-related variables were not (All p > 0.05).ConclusionsDA-CPR was not associated with better outcomes for traumatic OHCA in achieving a sustained ROSC. The DA-CPR program for traumatic OHCAs needs further studies to validate its effectiveness and practicability, especially in the communities where rules for the termination of resuscitation in prehospital settings do not exist.

Highlights

Out-of-hospital cardiac arrest (OHCA) is a major public health concern
Bystander cardiopulmonary resuscitation (CPR) was defined as an ongoing CPR by bystanders that were confirmed by the first Emergency medical technician (EMT) on the scene
Study objects Among the 7304 emergency medical services (EMS)-assessed OHCA cases during the study period, 4526 cases were included in the analysis after excluding paediatric (< 8 years) patients (n = 37), obvious deaths (n = 2048), hangings (n = 65), drownings (n = 61), lightning strikes (n = 6), and missing data (n = 561)

Summary

Introduction

Out-of-hospital cardiac arrest (OHCA) is a major public health concern. Dispatcher-assisted cardiopulmonary resuscitation (DACPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and . The resuscitation of traumatic OHCA is broadly considered ineffective; these efforts were not always futile [8]. 10% of traumatic OHCA cases who survived to hospital admission had good neurological outcomes [11]. Survival of traumatic cardiac arrests gradually increased over years [12]. Resuscitation efforts for traumatic patients with out-of-hospital cardiac arrest (OHCA) are not always futile. Dispatcher-assisted cardiopulmonary resuscitation (DA-CPR) during emergency calls could increase the rate of bystander cardiopulmonary resuscitation (CPR) and may enhance survival and neurologic outcomes of nontraumatic OHCA. This study aimed to examine the effectiveness of DA-CPR for traumatic OHCA

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