Document Detail

Traumatic cardiac arrest: should advanced life support be initiated?
MedLine Citation:
PMID:  23354262     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Several studies recommend not initiating advanced life support in traumatic cardiac arrest (TCA), mainly owing to the poor prognosis in several series that have been published. This study aimed to analyze the survival of the TCA in our series and to determine which factors are more frequently associated with recovery of spontaneous circulation (ROSC) and complete neurologic recovery (CNR).
METHODS: This is a cohort study (2006-2009) of treatment benefits.
RESULTS: A total of 167 TCAs were analyzed. ROSC was obtained in 49.1%, and 6.6% achieved a CNR. Survival rate by age groups was 23.1% in children, 5.7% in adults, and 3.7% in the elderly (p < 0.05). There was no significant difference in ROSC according to which type of ambulance arrived first, but if the advanced ambulance first, 9.41% achieved a CNR, whereas only 3.7% if the basic ambulance first. We found significant differences between the response time and survival with a CNR (response time was 6.9 minutes for those who achieved a CNR and 9.2 minutes for those who died). Of the patients, 67.5% were in asystole, 25.9% in pulseless electrical activity (PEA), and 6.6% in VF. ROSC was achieved in 90.9% of VFs, 60.5% of PEAs, and 40.2% of those in asystole (p < 0.05), and CNR was achieved in 36.4% of VFs, 7% of PEAs, and 2.7% of those in asystole (p < 0.05). The mean (SD) quantity of fluid replacement was greater in ROSC (1,188.8 [786.7] mL of crystalloids and 487.7 [688.9] mL of colloids) than in those without ROSC (890.4 [622.4] mL of crystalloids and 184.2 [359.3] mL of colloids) (p < 0.05).
CONCLUSION: In our series, 6.6% of the patients survived with a CNR. Our data allow us to state beyond any doubt that advanced life support should be initiated in TCA patients regardless of the initial rhythm, especially in children and those with VF or PEA as the initial rhythm and that a rapid response time and aggressive fluid replacement are the keys to the survival of these patients.
LEVEL OF EVIDENCE: Therapeutic study, level IV; epidemiologic study, level III.
Carmen Camacho Leis; Consuelo Canencia Hernández; Ma José Garcia-Ochoa Blanco; Paloma Covadonga Rey Paterna; Ramón de Elias Hernández; Ervigio Corral Torres
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  The journal of trauma and acute care surgery     Volume:  74     ISSN:  2163-0763     ISO Abbreviation:  J Trauma Acute Care Surg     Publication Date:  2013 Feb 
Date Detail:
Created Date:  2013-01-28     Completed Date:  2013-04-05     Revised Date:  2013-09-25    
Medline Journal Info:
Nlm Unique ID:  101570622     Medline TA:  J Trauma Acute Care Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  634-8     Citation Subset:  AIM; IM    
SAMUR-Protección Civil, Madrid. Spain.
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MeSH Terms
Advanced Cardiac Life Support*
Age Factors
Child, Preschool
Fluid Therapy
Heart Arrest / etiology,  mortality,  therapy*
Infant, Newborn
Kaplan-Meier Estimate
Middle Aged
Retrospective Studies
Survival Analysis
Time Factors
Treatment Outcome
Wounds and Injuries / complications*,  mortality,  therapy
Comment In:
J Trauma Acute Care Surg. 2013 Aug;75(2):348   [PMID:  23887578 ]
J Trauma Acute Care Surg. 2013 Aug;75(2):347-8   [PMID:  23887577 ]

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