BACKGROUND: Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to (1) describe the management and outcomes of prehospital traumatic arrests; (2) determine regional variation in survival; and (3) identify Advanced Life Support (ALS) procedures associated with survival. METHODS: This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma (PROPHET) registries. Patients were included if they had a blunt or penetrating injury and received cardiopulmonary resuscitation. Logistic regression analyses were used to determine the association between ALS procedures and survival. RESULTS: We included 2, 300 patients who were predominately young (Epistry mean [SD], 39 years; PROPHET mean [SD], 40 years), males (79%), injured by blunt trauma (Epistry, 68%; PROPHET, 67%), and treated by ALS paramedics (Epistry, 93%; PROPHET, 98%). A total of 145 patients (6. 3%) survived to hospital discharge. More patients with blunt (Epistry, 8. 3%; PROPHET, 6. 5%) vs. penetrating injuries (Epistry, 4. 6%; PROPHET, 2. 7%) survived. Most survivors (81%) had vitals on emergency medical services arrival. Rates of survival varied significantly between the 12 study sites (p = 0. 048) in the Epistry but not PROPHET (p = 0. 14) registries. Patients in the PROPHET registry who received a supraglottic airway insertion or intubation experienced decreased odds of survival (adjusted OR, 0. 27; 95% confidence interval, 0. 08-0. 93; and 0. 37; 95% confidence interval, 0. 17-0. 78, respectively) compared to those receiving bag-mask ventilation. No other procedureswere associatedwith survival. CONCLUSIONS: Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on emergency medical services arrival. Although limited by confounding and statistical power, no ALS procedures were associated with increased odds of survival.
Bibliographical noteFunding Information:
The ROC is supported by a series of cooperative agreements to nine regional clinical centers and one data coordinating center (5U01 HL077863-University of Washington Data Coordinating Center, HL077866-Medical College of Wisconsin; HL077867-University of Washington; HL077871-University of Pittsburgh; HL077872-St. Michael's Hospital; HL077873-Oregon Health and Science University; HL077881-University of Alabama at Birmingham; HL077885-Ottawa Hospital Research Institute; HL077887-University of Texas SW Medical Center/Dallas; HL077908-University of California San Diego) from the National Heart, Lung and Blood Institute in partnership with the US Army Medical Research & Material Command, The Canadian Institutes of Health Research (CIHR)-Institute of Circulatory and Respiratory Health, Defence Research and Development Canada, the Heart, Stroke Foundation of Canada, and the American Heart Association. The content is solely the responsibility of the authors and does not necessarily represent the official views of theNational Heart, Lung and Blood Institute or the National Institutes of Health.
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- Cardiac arrest
- Emergency medical services