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Emerg Med J. 2017 Jan;34(1):34-38. doi: 10.1136/emermed-2014-204596. Epub 2016 Oct 26.

Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest.

Author information

1
Emergency Medical Service Department, Beaujon University Hospital, Clichy, France.
2
Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris Sud, Université Paris Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.
3
Department of Anaesthesiology and Intensive Care, Pitié Salpétrière University Hospital, Paris, France.
4
Department of Anaesthesiology and Critical Care, Beaujon University Hospital, Clichy, France.
5
Université Denis Diderot-Paris VII, Paris, France.

Abstract

BACKGROUND:

Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA.

METHODS:

This study is a retrospective database review of all patients from a multicentre prospective registry that experienced a TCA and had undergone successful cardiopulmonary resuscitation (CPR) prior their admission at the trauma centre. The primary end point was neurological outcome at 6 months among patients who survived to hospital discharge.

RESULTS:

88 victims of TCA underwent successful CPR and were admitted to the hospital, 90% of whom were victims of blunt trauma. Of these 88 patients, 10 patients (11%; CI 95% 6% to 19%) survived to discharge: on discharge, 9 patients displayed a GCS of 15 and Cerebral Performance Categories (CPC) 1-2 and one patient had a GCS 7 and CPC of 3. Hypoxia was the most frequent cause of CA among survivors. 6-month follow-up was achieved for 9 patients of the 10 surviving patients. The 9 patients with a good outcome on hospital discharge had a CPC of 1 or 2 6 months post discharge. All returned to their premorbid family and social settings.

CONCLUSIONS:

Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile.

KEYWORDS:

Trauma, majot trauma management; cardiac arrest; pre-hospital

PMID:
27797869
DOI:
10.1136/emermed-2014-204596
[Indexed for MEDLINE]

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