Aim

In this study, we examine the impact of a trauma-based resuscitation protocol on survival outcomes following emergency medical services (EMS) witnessed traumatic out-of-hospital cardiac arrest (OHCA).

Methods

We included EMS-witnessed OHCAs arising from trauma and occurring between 2008 and 2019. In December 2016, a new resuscitation protocol for traumatic OHCA was introduced prioritising the treatment of potentially reversible causes before conventional cardiopulmonary resuscitation. The effect of the new protocol on survival outcomes was assessed using adjusted multivariable logistic regression models.

Results

Paramedics attempted resuscitation on 490 patients, with 341 (69.6%) and 149 (30.4%) occurring during the control and intervention periods, respectively. A reduction in the proportion of cases receiving cardiopulmonary resuscitation and epinephrine administration were found in the intervention period compared to the control period, whereas trauma-based interventions increased significantly, including blood administration (pre-arrest: 17.9% vs 3.7%; intra-arrest: 24.1% vs 2.7%), splinting (pre-arrest: 38.6% vs 17.1%; intra-arrest: 20.7% vs 5.2%), and finger thoracostomy (pre-arrest: 13.1% vs 0.6%; intra-arrest: 22.8% vs 0.9%), respectively, with p-values < 0.001 for all comparisons. After adjustment, the trauma-based resuscitation protocol was not associated with an improvement in survival to hospital discharge (AOR 1.29, 95% CI: 0.51–3.23), event survival (AOR 0.72, 95% CI: 0.41–1.28) or prehospital return of spontaneous circulation (AOR 0.63, 95% CI: 0.39–1.03).

Conclusion

In our region, the introduction of a trauma-based resuscitation protocol led to an increase in the delivery of almost all trauma interventions; however, this did not translate into better survival outcomes following EMS-witnessed traumatic OHCA.

中文翻译：

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在引入基于创伤的复苏方案后，急救医疗服务的生存结果见证了创伤性院外心脏骤停

目的

在这项研究中，我们研究了基于创伤的复苏方案对紧急医疗服务 (EMS) 目睹的外伤性院外心脏骤停 (OHCA) 后生存结果的影响。

方法

我们纳入了 EMS 目击的 2008 年至 2019 年间发生的由外伤引起的 OHCA。2016 年 12 月，引入了新的外伤性 OHCA 复苏方案，在常规心肺复苏之前优先治疗潜在的可逆原因。使用调整后的多变量逻辑回归模型评估新方案对生存结果的影响。

结果

护理人员对 490 名患者进行了复苏尝试，其中控制和干预期间分别发生了 341 名（69.6%）和 149 名（30.4%）。与对照组相比，干预期间接受心肺复苏和肾上腺素给药的病例比例减少，而基于创伤的干预措施显着增加，包括血液给药（逮捕前：17.9% vs 3.7%；逮捕中：24.1% 与 2.7%）、夹板（逮捕前：38.6% 与 17.1%；逮捕中：20.7% 与 5.2%）和手指开胸术（逮捕前：13.1% 与 0.6%；逮捕中：22.8 % vs 0.9%），所有比较的 p 值 < 0.001。调整后，基于创伤的复苏方案与出院存活率的改善无关（AOR 1.29，95% CI：0.51–3.23），

结论

在我们地区，基于创伤的复苏方案的引入导致几乎所有创伤干预措施的提供；然而，这并没有转化为 EMS 目睹的创伤性 OHCA 后更好的生存结果。