Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study.

Thymen Houwen,Mark G Van Vledder,Anna-Marie R Leemeyer,Marcel A.N De Bruijn,Maartje Terra,Zar Popal,Esther M.M Van Lieshout,Joost H Peters,Michael H.J Verhofstad

doi:10.1016/j.injury.2021.02.088

Abstract

Traumatic cardiac arrest (TCA) is a severe and life-threatening situation that mandates urgent action. Outcomes after on-scene treatment of TCA in the Netherlands are currently unknown. The aim of the current study was to investigate the rate of survival to discharge in patients who suffered from traumatic cardiac arrest and who were subsequently treated on-scene by the Dutch Helicopter Emergency Medical Services (HEMS). A retrospective cohort study was performed including patients ≥ 18 years with TCA for which the Dutch HEMS were dispatched between January 1st 2014 and December 31st 2018. Patients with TCA after hanging, submersion, conflagration or electrocution were excluded. The primary outcome measure was survival to discharge after prehospital TCA. Secondary outcome measures were return of spontaneous circulation (ROSC) on-scene and neurological status at hospital discharge. Nine-hundred-fifteen patients with confirmed TCA were included. ROSC was achieved on-scene in 261 patients (28.5%). Thirty-six (3.9%) patients survived to hospital discharge of which 17 (47.2%) had a good neurological outcome. Age < 70 years (0.7% vs. 5.2%; p=0.041) and a shockable rhythm on first ECG (OR 0.65 95%CI 0.02-0.28; p<0.001) were associated with increased odds of survival. Neurologic intact survival is possible after prehospital traumatic cardiac arrest. Younger patients and patients with a shockable ECG rhythm have higher survival rates after TCA. prognostic study, level III.

Highlights

Cardiac arrest after trauma is a severe and life-threatening situation that mandates urgent action
The aim of the current study was to investigate the rate of survival to discharge in patients who suffered from traumatic cardiac arrest and who were subsequently treated on-scene by the Dutch Helicopter Emergency Medical Services (HEMS)
Neurologic intact survival is possible after prehospital traumatic cardiac arrest

Summary

Introduction

Cardiac arrest after trauma is a severe and life-threatening situation that mandates urgent action. Reversible causes for circulatory arrest in the trauma setting include 1) hypoxia due to airway obstruction or apnea (resulting from severe traumatic brain injury or high spinal cord injuries), 2) exsanguination from major vessel injuries or pelvic fractures and 3) obstructive shock due to cardiac tamponade or tension pneumothorax. These injuries or injury sequelae can and should be addressed as soon as possible, preferably before the patient is transported to the hospital. The aim of the current study was to investigate the rate of survival to discharge in patients who suffered from traumatic cardiac arrest and who were subsequently treated on-scene by the Dutch Helicopter Emergency Medical Services (HEMS)

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