Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest

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10 Citations (Scopus)

Abstract

Background This study aimed to understand factors associated with paramedics’ decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10 min in patients who die at the scene. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. Results Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p = 0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR) = 18.52, 95% confidence interval (CI):6.68–51.36) or pulseless electrical activity (AOR = 12.58, 95%CI:9.06–17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR = 2.49, 95%CI:1.60–3.86), fall (AOR = 1.91, 95%CI:1.17–3.11) and shooting/stabbing (AOR = 2.25, 95%CI:1.17–4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR = 0.64, 95%CI:0.46–0.90). Resuscitation attempts ≤10 min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p = 0.314). Conclusion Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10 min may under-represent survival in those patients that receive full resuscitation attempts.

Original languageEnglish
Pages (from-to)14-21
Number of pages8
JournalResuscitation
Volume111
DOIs
Publication statusPublished - 1 Feb 2017

Keywords

  • Cardiac arrest
  • Cardiopulmonary resuscitation
  • Emergency medical service
  • Trauma

Cite this

@article{6020bb14729d4781abfa4036bd316959,
title = "Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest",
abstract = "Background This study aimed to understand factors associated with paramedics’ decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10 min in patients who die at the scene. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. Results Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28{\%} of cases and this rate remained steady over time (p = 0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR) = 18.52, 95{\%} confidence interval (CI):6.68–51.36) or pulseless electrical activity (AOR = 12.58, 95{\%}CI:9.06–17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR = 2.49, 95{\%}CI:1.60–3.86), fall (AOR = 1.91, 95{\%}CI:1.17–3.11) and shooting/stabbing (AOR = 2.25, 95{\%}CI:1.17–4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR = 0.64, 95{\%}CI:0.46–0.90). Resuscitation attempts ≤10 min represented 34{\%} of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8{\%} to 5.0{\%} (p = 0.314). Conclusion Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10 min may under-represent survival in those patients that receive full resuscitation attempts.",
keywords = "Cardiac arrest, Cardiopulmonary resuscitation, Emergency medical service, Trauma",
author = "Ben Beck and Bray, {Janet E.} and Peter Cameron and Lahn Straney and Emily Andrew and Stephen Bernard and Karen Smith",
year = "2017",
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day = "1",
doi = "10.1016/j.resuscitation.2016.11.011",
language = "English",
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Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. / Beck, Ben; Bray, Janet E.; Cameron, Peter; Straney, Lahn; Andrew, Emily; Bernard, Stephen; Smith, Karen.

In: Resuscitation, Vol. 111, 01.02.2017, p. 14-21.

Research output: Contribution to journalArticleResearchpeer-review

TY - JOUR

T1 - Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest

AU - Beck, Ben

AU - Bray, Janet E.

AU - Cameron, Peter

AU - Straney, Lahn

AU - Andrew, Emily

AU - Bernard, Stephen

AU - Smith, Karen

PY - 2017/2/1

Y1 - 2017/2/1

N2 - Background This study aimed to understand factors associated with paramedics’ decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10 min in patients who die at the scene. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. Results Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p = 0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR) = 18.52, 95% confidence interval (CI):6.68–51.36) or pulseless electrical activity (AOR = 12.58, 95%CI:9.06–17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR = 2.49, 95%CI:1.60–3.86), fall (AOR = 1.91, 95%CI:1.17–3.11) and shooting/stabbing (AOR = 2.25, 95%CI:1.17–4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR = 0.64, 95%CI:0.46–0.90). Resuscitation attempts ≤10 min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p = 0.314). Conclusion Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10 min may under-represent survival in those patients that receive full resuscitation attempts.

AB - Background This study aimed to understand factors associated with paramedics’ decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10 min in patients who die at the scene. Methods The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. Results Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p = 0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR) = 18.52, 95% confidence interval (CI):6.68–51.36) or pulseless electrical activity (AOR = 12.58, 95%CI:9.06–17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR = 2.49, 95%CI:1.60–3.86), fall (AOR = 1.91, 95%CI:1.17–3.11) and shooting/stabbing (AOR = 2.25, 95%CI:1.17–4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR = 0.64, 95%CI:0.46–0.90). Resuscitation attempts ≤10 min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p = 0.314). Conclusion Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10 min may under-represent survival in those patients that receive full resuscitation attempts.

KW - Cardiac arrest

KW - Cardiopulmonary resuscitation

KW - Emergency medical service

KW - Trauma

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U2 - 10.1016/j.resuscitation.2016.11.011

DO - 10.1016/j.resuscitation.2016.11.011

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SP - 14

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JO - Resuscitation

JF - Resuscitation

SN - 0300-9572

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