A novel scoring system using easily assessible predictors of return of spontaneous circulation and mortality in traumatic out-of-hospital cardiac arrest patients: A retrospective cohort study. (August 2022)

• Record Type: Journal Article
• Authors: Kuo, I-Ming; Chen, Yi-Fu; Chien, Chih-Ying; Hong, Yi-Wen; Kang, Shih-Ching; Fu, Chih-Yuan; Hsu, Chih-Po; Liao, Chien-Hung; Hsieh, Chi-Hsun
• Is Part Of: International journal of surgery. Volume 104(2022)
• Publication Date: 2022-08
• Subjects: Traumatic out-of-hospital cardiac arrest -- Traumatic cardiac arrest -- Return of spontaneous circulation -- Scoring system -- Priority -- Triage; Surgery -- Periodicals; Surgical Procedures, Operative -- Periodicals; 617.005
• DOI: 10.1016/j.ijsu.2022.106731
• Languages: English
• ISSNs: 1743-9191

Abstract

Abstract: Background: An accident event may necessitate triage of multiple cases of traumatic out-of-hospital cardiac arrest (TOHCA). However, factors for prioritizing treatment among multiple TOHCA patients have not been established. This study aims to use easily assessible predictors of TOHCA outcomes to develop a triage scoring system. Methods: Patients with TOHCA brought to our hospital by emergency medical services (EMS) were included for analysis to identify independent risk factors for poor outcomes. A scoring system was developed and validated internally and externally. Results: Of the 401 included patients, 86 (21.4%) had return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) for 30 min (81 patients, 94.2%) or 45 min (86 patients, 100%). The emergency department (ED) mortality rate was 89.3% and overall in-hospital mortality rate was 99%. Univariate and multivariate analyses identified body temperature <33 °C (OR, 4.65; 95% CI, 1.37–15.86), obvious chest injury (OR, 2.11; 95% CI, 1.03–4.34), and presumable etiology of out-of-hospital cardiac arrest (OR, 1.73; 95% CI, 1.01–2.98) as significant independent risk factors for non-ROSC. The TOHCA score, calculated as 1 point per risk factor, correlated significantly with the rate of non-ROSC and ED mortality (TOHCA score 0, 1, 2, 3: non-ROSC rate, 63.0%, 80.4%, 90.8%, 100%, respectively; ED mortality rate, 79.5%, 91.5%, 96.1%, and 100% respectively). The results of internal and external validations show a similar trend in both non-ROSC and mortality in the ED with increasing score. Conclusions: Termination of CPR for TOHCA after 45 min is reasonable; a 30-min resuscitation is acceptable in case of insufficient medical staff or resources. The TOHCA score may be able to be used with caution for triage. Graphical abstract: Image 1 Highlights: Traumatic Out-of-hospital cardiac arrest (TOHCA) is an important public health issue and a leading cause of mortality in most countries. Terminating cardiopulmonary resuscitation (CPR) after a 30-min resuscitation is acceptable for striking a balance between ethical concerns and limited medical resources. Those with score 0 have higher return of spontaneous circulation (ROSC) rate and survival to emergency department (ED) discharge rate.