学术急诊医学档案

卷 13 编号 1 (2025)

Pre-hospital Associated Factors of Survival in Traumatic Out-of-hospital Cardiac Arrests: An 11-Year Retrospective Cohort Study

学术急诊医学档案, 卷 13 编号 1 (2025), 6 九月 2025 , 第 e15 页
https://doi.org/10.22037/aaem.v13i1.2458

摘要

Introduction: Traumatic out-of-hospital cardiac arrest (TOHCA) presents significant public health challenges. The high accident rates and variability in prehospital management in Thailand further complicate TOHCA treatment. This study aimed to analyze prehospital prognostic factors of survival in TOHCA cases.

Methods: This study is a retrospective cohort study utilizing data from the Information Technology of Emergency Medicine System (ITEMS) from January 2012 to December 2022. It included TOHCA patients who received prehospital care and were transported to the emergency department (ED). We used an exploratory approach, incorporating all prognostic variables into a multivariable logistic regression model. Results are presented as odds ratios (OR) with 95% confidence intervals (CIs) and p-values.

Results: Over an 11-year period, 35,724 patients with the mean age of 39.69±20.53 (range: 1-99) years were included in the final analysis (78.69% male). Of these, 6,590 (18.45%) survived to hospital admission, while 29,134 (81.55%) died in the ED. Prehospital management factors significantly increasing the likelihood of survival to hospital admission included stopping bleeding (OR=1.38, 95% CI=1.24-1.54, P<0.001), endotracheal intubation (ETT) (OR=2.09, 95% CI=1.74-2.50, P<0.001), intravenous fluid administration (OR=1.66, 95% CI=1.35-2.05, P<0.001), defibrillation (OR = 2.35, 95% CI=1.96-2.81, P<0.001), age (aOR = 0.99, 95% CI = 0.98-0.99, P < 0.001), closed fracture (aOR = 0.59, 95% CI = 0.53-0.66, P < 0.001), open fracture (aOR = 0.54, 95% CI = 0.48-0.61, P < 0.001), dislocation (aOR = 0.60, 95% CI = 0.45-0.81, P = 0.001), and on scene time <10 min (aOR = 0.63, 95% CI = 0.54-0.75, P < 0.001).

Conclusions: To improve survival to hospital admission in TOHCA, several factors should be prioritized. These include administering intravenous fluid boluses, controlling external bleeding, delivering defibrillation when indicated, and performing ETT.

关键词:
  • Wounds and Injuries
  • Out-of-hospital cardiac arrest
  • Emergency Medical Services
  • Emergency Service, Hospital
  • Advanced Trauma Life Support Care
  • Prognosis

参考

Jun GS, Kim JG, Choi HY, Kang GH, Kim W, Jang YS, et al. Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: a nationwide observational study. Clin Exp Emerg Med. 2020;7(1):14-20.

Roh SY, Choi JI, Park SH, Kim YG, Shim J, Kim JS, et al. The 10-Year Trend of Out-of-hospital Cardiac Arrests: a Korean Nationwide Population-Based Study. Korean Circ J. 2021;51(10):866-74.

Huang JB, Lee KH, Ho YN, Tsai MT, Wu WT, Cheng FJ. Association between prehospital prognostic factors on out-of-hospital cardiac arrest in different age groups. BMC Emerg Med. 2021;21(1):3.

Beck B, Bray JE, Cameron P, Straney L, Andrew E, Bernard S, et al. Resuscitation attempts and duration in traumatic out-of-hospital cardiac arrest. Resuscitation. 2017;111:14-21.

Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales - A retrospective database analysis. Resuscitation. 2017;110:90-4.

Leis CC, Hernández CC, Blanco MJ, Paterna PC, Hernández Rde E, Torres EC. Traumatic cardiac arrest: should advanced life support be initiated? J Trauma Acute Care Surg. 2013;74(2):634-8.

WHO. Global status report on road safety2023.

Evans CC, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, et al. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81(2):285-93.

Serpa E, Zimmerman SO, Bauman ZM, Kulvatunyou N. A Contemporary Study of Pre-hospital Traumatic Cardiac Arrest: Distinguishing Exsanguination From Non-exsanguination Arrest With a Review of Current Literature. Cureus. 2023;15(11):e48181.

Amacher SA, Bohren C, Blatter R, Becker C, Beck K, Mueller J, et al. Long-term Survival After Out-of-Hospital Cardiac Arrest: A Systematic Review and Meta-analysis. JAMA Cardiol. 2022;7(6):633-43.

Tran A, Fernando SM, Rochwerg B, Vaillancourt C, Inaba K, Kyeremanteng K, et al. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest - A systematic review and meta-analysis. Resuscitation. 2020;153:119-35.

Sirikul W, Piankusol C, Wittayachamnankul B, Riyapan S, Supasaovapak J, Wongtanasarasin W, et al. A retrospective multi-centre cohort study: Pre-hospital survival factors of out-of-hospital cardiac arrest (OHCA) patients in Thailand. Resusc Plus. 2022;9:100196.

Wang SA, Chang CJ, Do Shin S, Chu SE, Huang CY, Hsu LM, et al. Development of a prediction model for emergency medical service witnessed traumatic out-of-hospital cardiac arrest: A multicenter cohort study. J Formos Med Assoc. 2024;123(1):23-35.

Lockey D, Crewdson K, Davies G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med. 2006;48(3):240-4.

Aoki M, Abe T, Oshima K. Association of Prehospital Epinephrine Administration With Survival Among Patients With Traumatic Cardiac Arrest Caused By Traffic Collisions. Sci Rep. 2019;9(1):9922.

Kim JG, Lee J, Choi HY, Kim W, Kim J, Moon S, et al. Outcome analysis of traumatic out-of-hospital cardiac arrest patients according to the mechanism of injury: A nationwide observation study. Medicine (Baltimore). 2020;99(45):e23095.

Sittichanbuncha Y, Prachanukool T, Sarathep P, Sawanyawisuth K. An emergency medical service system in Thailand: providers' perspectives. J Med Assoc Thai. 2014;97(10):1016-21.

Pochaisan O, Pattanarattanamolee R, Pongphuttha W, Chadbunchachai W, Nakahara S. Development of an emergency medical services system in Thailand: Roles of the universal health coverage and the national lead agency. Emerg Med Australas. 2021;33(4):756-8.

Cabral E, Castro WRS, Florentino DRM, Viana DA, Costa Junior JFD, Souza RP, et al. Response time in the emergency services. Systematic review. Acta Cir Bras. 2018;33(12):1110-21.

Pham H, Puckett Y, Dissanaike S. Faster on-scene times associated with decreased mortality in Helicopter Emergency Medical Services (HEMS) transported trauma patients. Trauma Surg Acute Care Open. 2017;2(1):e000122.

Olascoaga Arrate A, Freijo Guerrero MM, Fernández Maiztegi C, Azkune Calle I, Silvariño Fernández R, Fernández Rodríguez M, et al. Use of emergency medical transport and impact on time to care in patients with ischaemic stroke. Neurologia (Engl Ed). 2019;34(2):80-8.

Böttiger BW, Bernhard M, Knapp J, Nagele P. Influence of EMS-physician presence on survival after out-of-hospital cardiopulmonary resuscitation: systematic review and meta-analysis. Crit Care. 2016;20:4.

Kuo IM, Chen YF, Chien CY, Hong YW, Kang SC, Fu CY, et al. 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. Int J Surg. 2022;104:106731.

Millin MG, Galvagno SM, Khandker SR, Malki A, Bulger EM. Withholding and termination of resuscitation of adult cardiopulmonary arrest secondary to trauma: resource document to the joint NAEMSP-ACSCOT position statements. J Trauma Acute Care Surg. 2013;75(3):459-67.

Yuksen C, Phattharapornjaroen P, Kreethep W, Suwanmano C, Jenpanitpong C, Nonnongku R, et al. Bag-Valve Mask versus Endotracheal Intubation in Out-of-Hospital Cardiac Arrest on Return of Spontaneous Circulation: A National Database Study. Open Access Emerg Med. 2020;12:43-6.

Chen YC, Wu KH, Hsiao KY, Hung MS, Lai YC, Chen YS, et al. Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury. 2019;50(1):4-9.

Smida T, Price BS, Scheidler J, Crowe R, Wilson A, Bardes J. Stay and play or load and go? The association of on-scene advanced life support interventions with return of spontaneous circulation following traumatic cardiac arrest. Eur J Trauma Emerg Surg. 2023;49(5):2165-72.

McMullan J, Gerecht R, Bonomo J, Robb R, McNally B, Donnelly J, et al. Airway management and out-of-hospital cardiac arrest outcome in the CARES registry. Resuscitation. 2014;85(5):617-22.

Saar S, Lomp A, Laos J, Mihnovitš V, Šalkauskas R, Lustenberger T, et al. Population-Based Autopsy Study of Traumatic Fatalities. World J Surg. 2017;41(7):1790-5.

Harris T, Masud S, Lamond A, Abu-Habsa M. Traumatic cardiac arrest: a unique approach. Eur J Emerg Med. 2015;22(2):72-8.

Kutcher ME, Forsythe RM, Tisherman SA. Emergency preservation and resuscitation for cardiac arrest from trauma. Int J Surg. 2016;33(Pt B):209-12.

Vassallo J, Nutbeam T, Rickard AC, Lyttle MD, Scholefield B, Maconochie IK, et al. Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Emerg Med J. 2018;35(11):669-74.

Evans C, Quinlan DO, Engels PT, Sherbino J. Reanimating Patients After Traumatic Cardiac Arrest: A Practical Approach Informed by Best Evidence. Emerg Med Clin North Am. 2018;36(1):19-40.

Lee HM, Wang CT, Hsu CC, Chen KT. Algorithm to Improve Resuscitation Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest. Cureus. 2022;14(3):e23194.

Deasy C, Bray J, Smith K, Harriss L, Morrison C, Bernard S, et al. Traumatic out-of-hospital cardiac arrests in Melbourne, Australia. Resuscitation. 2012;83(4):465-70.

Irfan FB, Consunji R, El-Menyar A, George P, Peralta R, Al-Thani H, et al. Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: A nationwide population-based study. Int J Cardiol. 2017;240:438-43.

Beck B, Bray JE, Cameron P, Straney L, Andrew E, Bernard S, et al. Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors. Emerg Med J. 2017;34(12):786-92.

Krychtiuk KA, Richter B, Lenz M, Hohensinner PJ, Huber K, Hengstenberg C, et al. Epinephrine treatment but not time to ROSC is associated with intestinal injury in patients with cardiac arrest. Resuscitation. 2020;155:32-8.

Yamamoto R, Suzuki M, Hayashida K, Yoshizawa J, Sakurai A, Kitamura N, et al. Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study. Scand J Trauma Resusc Emerg Med. 2019;27(1):74.

Escutnaire J, Genin M, Babykina E, Dumont C, Javaudin F, Baert V, et al. Traumatic cardiac arrest is associated with lower survival rate vs. medical cardiac arrest - Results from the French national registry. Resuscitation. 2018;131:48-54.

Harmsen AM, Giannakopoulos GF, Moerbeek PR, Jansma EP, Bonjer HJ, Bloemers FW. The influence of prehospital time on trauma patients outcome: a systematic review. Injury. 2015;46(4):602-9.

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