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Witnessed prehospital traumatic arrest: predictors of survival to hospital discharge

  • Original Article
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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript

Abstract

Purpose

Trauma patients are rapidly transported to the hospital for definitive care. Nonetheless, some are alive upon Emergency Medical Services (EMS) arrival but arrest on-scene or during transport. The study objective was to examine EMS-witnessed traumatic arrests to define patients who survived hospital discharge.

Methods

Patients sustaining EMS-witnessed traumatic arrest and entered into the National Trauma Data Bank were included (2007–2018). Mortality defined groups: survival to hospital discharge vs. in-hospital death vs. death in ED/declared dead on arrival (DOA). ANOVA/Chi-square compared cohorts. Multivariable analysis established factors associated with survival out of ED and to hospital discharge.

Results

After exclusions, 14,177 patients met the criteria: 10% survived, 22% died in hospital, and 68% died in ED/DOA. Survivors tended to be female (33% vs. 23% vs. 23%, p < 0.001), blunt traumas (71% vs. 56% vs. 60%, p < 0.001), have higher scene GCS (15 [7–15] vs. 3 [3–11] vs. 3 [3–7], p < 0.001), and lower injury severity (ISS 13 [7–26] vs. 27 [18–41] vs. 25 [10–30], p < 0.001), particularly of the head (AIS 0 [0–2] vs. 0 [0–4] vs. 1 [0–4], p < 0.001). Survival to hospital discharge was independently associated with higher field GCS (OR 1.252, p < 0.001) and SBP (OR 1.006, p < 0.001), and Head AIS scores (OR 1.073, p < 0.001). Increasing age (OR 0.984, p < 0.001), higher ISS (OR 0.975, p < 0.001), male sex (OR 0.695, p < 0.001), and penetrating mechanism of injury (OR 0.537, p < 0.001) were associated with reduced survival to discharge.

Conclusion

After EMS-witnessed traumatic cardiac arrest, survivors were more likely to be young, female, injured by blunt trauma, and less hypotensive/comatose on-scene. These findings may have implications for ED resuscitation or declaration of care futility and should be further investigated with a prospective multicenter study.

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References

  1. Demetriades D, Chan L, Cornwell E, Belzberg H, Berne TV, Asensio J, Chan D, Eckstein M, Alo K. Paramedic vs private transportation of trauma patients. Effect on outcome. Arch Surg. 1996;131(2):133–8.

    Article  CAS  PubMed  Google Scholar 

  2. Carroll SL, Dye DW, Smedley WA, Stephens SW, Reiff DA, Kerby JD, Holcomb JB, Jansen JO. Early and prehospital trauma deaths: who might benefit from advanced resuscitative care? J Trauma Acute Care Surg. 2020;88(6):776–82.

    Article  PubMed  Google Scholar 

  3. Evans CC, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, Austin MA, Resuscitation Outcomes Consortium Investigators. 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.

    Article  PubMed  PubMed Central  Google Scholar 

  4. American College of Surgeons Committee on Trauma. About the National Trauma Data Bank (NTDB). 2022. https://www.facs.org/quality-programs/trauma/quality/national-trauma-data-bank/about-ntdb/. Accessed 21 Oct 2022

  5. Van Gent JM, Clements TW, Lubkin DT, Wade CE, Cardenas JC, Kao LS, Cotton BA. Predicting futility in severely injured patients: using arrival lab values and physiology to support evidence-based resource stewardship. J Am Coll Surg. 2023;236(4):874–80.

    Article  PubMed  Google Scholar 

  6. Taylor JR III, Fox EE, Holcomb JB, Rizoli S, Inaba K, Schreiber MA, Brasel K, Scalea TM, Wade CE, Bulger E, Cotton BA, PROPPR Study Group. The hyperfibrinolytic phenotype is the most lethal and resource intense presentation of fibrinolysis in massive transfusion patients. J Trauma Acute Care Surg. 2018;84(1):25–30.

    Article  PubMed  PubMed Central  Google Scholar 

  7. Holcomb JB, Tilley BC, Baraniuk S, Fox EE, Wade CE, Podbielski JM, del Junco DJ, Brasel KJ, Bulger EM, Callcut RA, Cohen MJ, Cotton BA, Fabian TC, Inaba K, Kerby JD, Muskat P, O’Keeffe T, Rizoli S, Robinson BR, Scalea TM, Schreiber MA, Stein DM, Weinberg JA, Callum JL, Hess JR, Matijevic N, Miller CN, Pittet JF, Hoyt DB, Pearson GD, Leroux B, van Belle G, PROPPR Study Group. Transfusion of plasma, platelets, and red blood cells in a 1:1:1 vs a 1:1:2 ratio and mortality in patients with severe trauma: the PROPPR randomized clinical trial. JAMA. 2015;313(5):471–82.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Rozycki GS, Ochsner MG, Feliciano DV, Thomas B, Boulanger BR, Davis FE, Falcone RE, Schmidt JA. Early detection of hemoperitoneum by ultrasound examination of the right upper quadrant: a multicenter study. J Trauma. 1998;45(5):878–83.

    Article  CAS  PubMed  Google Scholar 

  9. Rotondo MF, Schwab CW, McGonigal MD, Phillips GR 3rd, Fruchterman TM, Kauder DR, Latenser BA, Angood PA. ‘Damage control’: an approach for improved survival in exsanguinating penetrating abdominal injury. J Trauma. 1993;35(3):375–82 (discussion 382-3).

    Article  CAS  PubMed  Google Scholar 

  10. American College of Surgeons Committee on Trauma (2022) Resources for optimal care of the injured patient: 2022 Standards. Chicago

  11. Joseph B, Khan M, Jehan F, Latifi R, Rhee P. Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma Surg Acute Care Open. 2018;3(1): e000201.

    Article  PubMed  PubMed Central  Google Scholar 

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Funding

No funding was received for this study.

Author information

Authors and Affiliations

  1. Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, 2051 Marengo Street, Inpatient Tower, C5L100, Los Angeles, CA, 90033, USA

    Morgan Schellenberg, Natthida Owattanapanich, Chaiss Ugarte, Lydia Lam, Matthew J. Martin & Kenji Inaba

  2. Division of Acute Care Surgery, University of California Irvine, Irvine, CA, USA

    Areg Grigorian & Jeffry Nahmias

Authors
  1. Morgan Schellenberg
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  2. Natthida Owattanapanich
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  3. Chaiss Ugarte
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  4. Areg Grigorian
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  5. Jeffry Nahmias
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  6. Lydia Lam
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  7. Matthew J. Martin
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  8. Kenji Inaba
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Corresponding author

Correspondence to Morgan Schellenberg.

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Conflict of interest

Authors Schellenberg, Owattanapanich, Ugarte, Grigorian, Nahmias, Lam, Martin, and Inaba declare that they have no conflict of interest.

Ethical approval

All procedures performed in this retrospective observational study involving human participants were in accordance with the ethical standards of the Institutional Review Board of the University of California (HS-22-00061) and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

This study received a waiver for informed consent by the Institutional Review Board of the University of Southern California (HS-22-00061).

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Schellenberg, M., Owattanapanich, N., Ugarte, C. et al. Witnessed prehospital traumatic arrest: predictors of survival to hospital discharge. Eur J Trauma Emerg Surg (2023). https://doi.org/10.1007/s00068-023-02398-3

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  • DOI: https://doi.org/10.1007/s00068-023-02398-3

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