Predicting outcomes in traumatic out-of-hospital cardiac arrest

The relevance of Utstein factors

Research output: Contribution to journalArticleResearchpeer-review

9 Citations (Scopus)

Abstract

Background Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning. Results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24%) and 95 patients (14%) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95% CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95% CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95% CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95% CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95% CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95% CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95% CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital. Conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.

Original languageEnglish
Pages (from-to)786-792
Number of pages7
JournalEmergency Medicine Journal
Volume34
Issue number12
DOIs
Publication statusPublished - 1 Dec 2017

Keywords

  • Cardiac Arrest
  • Emergency Ambulance Systems
  • Trauma

Cite this

@article{8a963957374c41f38ef1d8552b51717f,
title = "Predicting outcomes in traumatic out-of-hospital cardiac arrest: The relevance of Utstein factors",
abstract = "Background Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning. Results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24{\%}) and 95 patients (14{\%}) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95{\%} CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95{\%} CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95{\%} CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95{\%} CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95{\%} CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95{\%} CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95{\%} CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital. Conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.",
keywords = "Cardiac Arrest, Emergency Ambulance Systems, Trauma",
author = "Ben Beck and Bray, {Janet E.} and Peter Cameron and Lahn Straney and Emily Andrew and Stephen Bernard and Karen Smith",
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month = "12",
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doi = "10.1136/emermed-2016-206330",
language = "English",
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pages = "786--792",
journal = "Emergency Medicine Journal",
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Predicting outcomes in traumatic out-of-hospital cardiac arrest : The relevance of Utstein factors. / Beck, Ben; Bray, Janet E.; Cameron, Peter; Straney, Lahn; Andrew, Emily; Bernard, Stephen; Smith, Karen.

In: Emergency Medicine Journal, Vol. 34, No. 12, 01.12.2017, p. 786-792.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Predicting outcomes in traumatic out-of-hospital cardiac arrest

T2 - The relevance of Utstein factors

AU - Beck, Ben

AU - Bray, Janet E.

AU - Cameron, Peter

AU - Straney, Lahn

AU - Andrew, Emily

AU - Bernard, Stephen

AU - Smith, Karen

PY - 2017/12/1

Y1 - 2017/12/1

N2 - Background Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning. Results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24%) and 95 patients (14%) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95% CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95% CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95% CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95% CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95% CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95% CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95% CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital. Conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.

AB - Background Given low survival rates in cases of traumatic out-of-hospital cardiac arrest (OHCA), there is a need to identify factors associated with outcomes. We aimed to investigate Utstein factors associated with achieving return of spontaneous circulation (ROSC) and survival to hospital in traumatic OHCA. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify cases of traumatic OHCA that received attempted resuscitation and occurred between July 2008 and June 2014. We excluded cases aged <16 years or with a mechanism of hanging or drowning. Results Of the 660 traumatic OHCA patients who received attempted resuscitation, ROSC was achieved in 159 patients (24%) and 95 patients (14%) survived to hospital (ROSC on hospital handover). Factors that were positively associated with achieving ROSC in multivariable logistic regression models were age ≥65 years (adjusted OR (AOR)=1.56, 95% CI: 1.01 to 2.43) and arresting rhythm (shockable (AOR=3.65, 95% CI: 1.64 to 8.11) and pulseless electrical activity (AOR=2.15, 95% CI: 1.36 to 3.39) relative to asystole). Similarly, factors positively associated with survival to hospital were arresting rhythm (shockable (AOR=3.92, 95% CI: 1.64 to 9.41) relative to asystole), and the mechanism of injury (falls (AOR=2.16, 95% CI: 1.03 to 4.54) relative to motor vehicle collisions), while trauma type (penetrating (AOR=0.27, 95% CI: 0.08 to 0.91) relative to blunt trauma) and event region (rural (AOR=0.39, 95% CI: 0.19 to 0.80) relative to urban) were negatively associated with survival to hospital. Conclusions Few patient and arrest characteristics were associated with outcomes in traumatic OHCA. These findings suggest there is a need to incorporate additional information into cardiac arrest registries to assist prognostication and the development of novel interventions in these trauma patients.

KW - Cardiac Arrest

KW - Emergency Ambulance Systems

KW - Trauma

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U2 - 10.1136/emermed-2016-206330

DO - 10.1136/emermed-2016-206330

M3 - Article

VL - 34

SP - 786

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JO - Emergency Medicine Journal

JF - Emergency Medicine Journal

SN - 1472-0205

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