Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study. Issue 5 (May 2021)

• Record Type: Journal Article
• Authors: Houwen, Thymen; Popal, Zar; de Bruijn, Marcel A.N.; Leemeyer, Anna-Marie R.; Peters, Joost H.; Terra, Maartje; van Lieshout, Esther M.M.; Verhofstad, Michael H.J.; van Vledder, Mark G.
• Is Part Of: Injury. Volume 52:Issue 5(2021)
• Page Start: 1117
• Page End: 1122
• Publication Date: 2021-05
• Subjects: Traumatic Cardiac Arrest (TCA) -- Helicopter Emergency Medical Service (HEMS) -- treatment on-scene -- Return of spontaneous circulation (ROSC) and survival to discharge; Wounds and injuries -- Surgery -- Periodicals; Accidents -- Periodicals; Wounds and Injuries -- surgery -- Periodicals; Lésions et blessures -- Chirurgie -- Périodiques; Electronic journals; Electronic journals; 617.1
• DOI: 10.1016/j.injury.2021.02.088
• Languages: English
• ISSNs: 0020-1383

Abstract

Abstract: Background: 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). Methods: A retrospective cohort study was performed including patients ≥ 18 years with TCA for which the Dutch HEMS were dispatched between January 1 st 2014 and December 31 st 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. Results: 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. Conclusion: 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. Level of evidence: prognostic study, level III.