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J R Army Med Corps. 2018 Jul;164(3):150-154. doi: 10.1136/jramc-2017-000818. Epub 2017 Oct 6.

The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry.

Author information

1
Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK.
2
Department of Seconded Medical Officers, Institute of Naval Medicine, Gosport, Hampshire, UK.
3
Emergency Department, James Cook University Hospital, Middlesbrough, UK.
4
Emergency Department, Frimley Park Hospital, Frimley, Surrey, UK.
5
Emergency Department, Derriford Hospital, Plymouth, UK.

Abstract

BACKGROUND:

The UK military was continuously engaged in armed conflict in Iraq and Afghanistan between 2003 and 2014, resulting in 629 UK fatalities. Traumatic cardiac arrest (TCA) is a precursor to traumatic death, but data on military outcomes are limited. In order to better inform military treatment protocols, the aim of this study was to define the epidemiology of TCA in the military population with a particular focus on survival rates and injury patterns.

METHODS:

A retrospective database analysis of the UK Joint Theatre Trauma Registry was undertaken. Patients who were transported to a UK deployed hospital between 2003 and 2014 and suffered TCA were included. Those patients injured by asphyxiation, electrocution, burns without other significant trauma and drowning were excluded. Data included mechanism of injury, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) for each body region and survival to deployed (Role 3) field hospital discharge.

RESULTS:

424 TCA patients were identified during the study period; median age was 23 years, with a median ISS of 45. The most common mechanism of injury was explosive (55.7%), followed by gunshot wound (38.9%), road traffic collision (3.5%), crush (1.7%) and fall (0.2%). 45 patients (10.6% (95% CI 8.0% to 13.9%)) survived to deployed (Role 3) hospital discharge. The most prevalent body region with a severe to maximum AIS injury was the head, followed by the lower limbs, thorax and abdomen. Haemorrhage secondary to abdominal and lower limb injury was associated with survival; traumatic brain injury was associated with death.

CONCLUSIONS:

This study has shown that short-term survival from TCA in a military population is 10.6%. With appropriate and aggressive early management, although unlikely, survival is still potentially possible in military patients who suffer traumatic cardiac arrest.

KEYWORDS:

epidemiology; military; rauma; traumatic cardiac arrest

PMID:
28988190
DOI:
10.1136/jramc-2017-000818
[Indexed for MEDLINE]

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