Ben Beck1, Janet E Bray2, Peter Cameron3, Lahn Straney4, Emily Andrew5, Stephen Bernard6, Karen Smith7. 1. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia. Electronic address: ben.beck@monash.edu. 2. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia; Prehospital, Resuscitation and Emergency Care Research Unit (PRECRU), School of Nursing, Midwifery and Paramedicine, Curtin University, Australia. 3. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia; Emergency and Trauma Centre, The Alfred Hospital, Australia. 4. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia. 5. Ambulance Victoria, Australia. 6. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia; Ambulance Victoria, Australia; Intensive Care Unit, Alfred Hospital, Victoria, Australia. 7. Department of Epidemiology and Preventive Medicine, School of Public Health & Preventive Medicine, Monash University, Australia; Ambulance Victoria, Australia; School of Primary, Aboriginal and Rural Health Care, University of Western Australia, Western Australia, Australia; Department of Community Emergency Health and Paramedic Practice, Monash University, Victoria, Australia.
Abstract
BACKGROUND: This study aimed to understand factors associated with paramedics' decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10min in patients who die at the scene. METHODS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. RESULTS: Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p=0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR)=18.52, 95% confidence interval (CI):6.68-51.36) or pulseless electrical activity (AOR=12.58, 95%CI:9.06-17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR=2.49, 95%CI:1.60-3.86), fall (AOR=1.91, 95%CI:1.17-3.11) and shooting/stabbing (AOR=2.25, 95%CI:1.17-4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR=0.64, 95%CI:0.46-0.90). Resuscitation attempts ≤10min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p=0.314). CONCLUSION: Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10min may under-represent survival in those patients that receive full resuscitation attempts.
BACKGROUND: This study aimed to understand factors associated with paramedics' decision to attempt resuscitation in traumatic out-of-hospital cardiac arrest (OHCA) and to characterise resuscitation attempts ≤10min in patients who die at the scene. METHODS: The Victorian Ambulance Cardiac Arrest Registry (VACAR) was used to identify all cases of traumatic OHCA between July 2008 and June 2014. We excluded cases <16 years of age or with a mechanism of hanging or drowning. RESULTS: Of the 2334 cases of traumatic OHCA, resuscitation was attempted in 28% of cases and this rate remained steady over time (p=0.10). Multivariable logistic regression revealed that the arresting rhythm [shockable (adjusted odds ratio (AOR)=18.52, 95% confidence interval (CI):6.68-51.36) or pulseless electrical activity (AOR=12.58, 95%CI:9.06-17.45) relative to asystole] and mechanism of injury [motorcycle collision (AOR=2.49, 95%CI:1.60-3.86), fall (AOR=1.91, 95%CI:1.17-3.11) and shooting/stabbing (AOR=2.25, 95%CI:1.17-4.31) relative to a motor vehicle collision] were positively associated with attempted resuscitation. Arrests occurring in rural regions had a significantly lower odds of attempted resuscitation relative to those in urban regions (AOR=0.64, 95%CI:0.46-0.90). Resuscitation attempts ≤10min represented 34% of cases in which resuscitation was attempted but the patient died at the scene. When these resuscitation attempts were selectively excluded from the overall EMS treated population, survival to hospital discharge non-significantly increased from 3.8% to 5.0% (p=0.314). CONCLUSION: Survival in our study was consistent with existing literature, however the large proportion of cases with resuscitation attempts ≤10min may under-represent survival in those patients that receive full resuscitation attempts.
Authors: Ben Beck; Karen Smith; Eric Mercier; Belinda Gabbe; Richard Bassed; Biswadev Mitra; Warwick Teague; Josine Siedenburg; Susan McLellan; Peter Cameron Journal: PLoS One Date: 2019-06-04 Impact factor: 3.240