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Grunau B, Bělohlávek J. Candidacy Assessment for Extracorporeal CPR in Out-of-Hospital Cardiac Arrest: Still Much to Learn. Chest 2024; 165:759-761. [PMID: 38599746 DOI: 10.1016/j.chest.2023.11.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Accepted: 11/21/2023] [Indexed: 04/12/2024] Open
Affiliation(s)
- Brian Grunau
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada; Departments of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Internal Medicine II, Cardiovascular Medicine, 1st Medical School, Charles University and General University Hospital, Prague, Czech Republic; Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland.
| | - Jan Bělohlávek
- British Columbia Resuscitation Research Collaborative, Vancouver, BC, Canada; Departments of Emergency Medicine, University of British Columbia and St. Paul's Hospital, Vancouver, BC, Canada; Department of Internal Medicine II, Cardiovascular Medicine, 1st Medical School, Charles University and General University Hospital, Prague, Czech Republic; Institute of Heart Diseases, Wrocław Medical University, Wrocław, Poland
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Arkins TP, Liao M, O'Donnell D, Glober N, Faris G, Weinstein E, Supples MW, Vaizer J, Hunter BR, Lardaro T. Description of the Public Safety Medical Response and Patient Encounters Within and During the Indianapolis (USA) Spring 2020 Civil Unrest. Prehosp Disaster Med 2024; 39:73-77. [PMID: 38269437 DOI: 10.1017/s1049023x24000025] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/26/2024]
Abstract
OBJECTIVE This study describes the local Emergency Medical Services (EMS) response and patient encounters corresponding to the civil unrest occurring over a four-day period in Spring 2020 in Indianapolis, Indiana (USA). METHODS This study describes the non-conventional EMS response to civil unrest. The study included patients encountered by EMS in the area of the civil unrest occurring in Indianapolis, Indiana from May 29 through June 1, 2020. The area of civil unrest defined by Indianapolis Metropolitan Police Department covered 15 blocks by 12 blocks (roughly 4.0 square miles) and included central Indianapolis. The study analyzed records and collected demographics, scene times, interventions, dispositions, EMS clinician narratives, transport destinations, and hospital course with outcomes from receiving hospitals for patients extracted from the area of civil unrest by EMS. RESULTS Twenty-nine patients were included with ages ranging from two to sixty-eight years. In total, EMS transported 72.4% (21 of 29) of the patients, with the remainder declining transport. Ballistic injuries from gun violence accounted for 10.3% (3 of 29) of injuries. Two additional fatalities from penetrating trauma occurred among patients without EMS contact within and during the civil unrest. Conditions not involving trauma occurred in 37.9% (11 of 29). Among transported patients, 33.3% (7 of 21) were admitted to the hospital and there was one fatality. CONCLUSIONS While most EMS transports did not result in hospitalization, it is important to note that the majority of EMS calls did result in a transport. There was a substantial amount of non-traumatic patient encounters. Trauma in many of the encounters was relatively severe, and the findings imply the need for rapid extraction methods from dangerous areas to facilitate timely in-hospital stabilization.
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Affiliation(s)
- Thomas P Arkins
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
| | - Mark Liao
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Daniel O'Donnell
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Nancy Glober
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Gregory Faris
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Elizabeth Weinstein
- Indianapolis Emergency Medical Services, Indianapolis, Indiana, USA
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Michael W Supples
- Department of Emergency Medicine, Wake Forest School of Medicine, Winston-Salem, North Carolina, USA
| | - Julia Vaizer
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Benton R Hunter
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
| | - Thomas Lardaro
- Department of Emergency Medicine, Indiana University School of Medicine, Indianapolis, Indiana, USA
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Schober P, Giannakopoulos GF, Bulte CSE, Schwarte LA. Traumatic Cardiac Arrest-A Narrative Review. J Clin Med 2024; 13:302. [PMID: 38256436 PMCID: PMC10816125 DOI: 10.3390/jcm13020302] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/19/2023] [Revised: 01/01/2024] [Accepted: 01/03/2024] [Indexed: 01/24/2024] Open
Abstract
A paradigm shift in traumatic cardiac arrest (TCA) perception switched the traditional belief of futility of TCA resuscitation to a more optimistic perspective, at least in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat the common potentially reversible causes of TCA. Advances in diagnostics and therapy in TCA are ongoing; however, they are not always translating into improved outcomes. Further research is needed to improve outcome in this often young and previously healthy patient population.
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Affiliation(s)
- Patrick Schober
- Department of Anesthesiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands; (P.S.)
- Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
| | - Georgios F. Giannakopoulos
- Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
- Department of Surgery, Amsterdam University Medical Center, 1105 AZ Amsterdam, The Netherlands
| | - Carolien S. E. Bulte
- Department of Anesthesiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands; (P.S.)
- Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
| | - Lothar A. Schwarte
- Department of Anesthesiology, Amsterdam University Medical Center, 1081 HV Amsterdam, The Netherlands; (P.S.)
- Helicopter Emergency Medical Service‚ Lifeliner 1, 1044 AN Amsterdam, The Netherlands
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4
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Perlman R, Tsai K, Lo J. Trauma Anesthesiology Perioperative Management Update. Adv Anesth 2023; 41:143-162. [PMID: 38251615 DOI: 10.1016/j.aan.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/23/2024]
Abstract
Anesthesia for patients with life-threatening injuries is an essential part of post-accident care. Unfortunately, there is variability in trauma anesthesia care and numerous nonstandardized methods of working with patients remain. Uncertainty exists as to when and how best to intubate trauma patients, the use of vasopressors, and the appropriate management of severe traumatic brain injury. Some physicians recommend prehospital rapid sequence intubation, whereas others use bag-mask ventilation at lower pressures with no cricoid pressure and early transport to a trauma center. Overall, the absence of uniformity in trauma anesthesia care underlines the need for continued study and dialogue to define best practices and optimize patient outcomes.
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Affiliation(s)
- Ryan Perlman
- Trauma Anesthesia, Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA.
| | - Kevin Tsai
- Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA
| | - Jessie Lo
- Trauma Education Program, Department of Anaesthesia, Cedars-Sinai Medical Center, 8700 Beverly Boulevard, North Tower, Suite 8211, Los Angeles, CA 90048, USA
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Levin JH, Pecoraro A, Ochs V, Meagher A, Steenburg SD, Hammer PM. Characterization of fatal blunt injuries using postmortem computed tomography. J Trauma Acute Care Surg 2023; 95:186-190. [PMID: 37068024 DOI: 10.1097/ta.0000000000004012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 04/18/2023]
Abstract
BACKGROUND Rapid triage of blunt agonal trauma patients is necessary to maximize survival, but autopsy is uncommon, slow, and rarely informs resuscitation guidelines. Postmortem computed tomography (PMCT) can serve as an adjunct to autopsy in guiding blunt agonal trauma resuscitation. METHODS Retrospective cohort review of trauma decedents who died at or within 1 hour of arrival following blunt trauma and underwent noncontrasted PMCT. Primary outcome was the prevalence of mortal injury defined as potential exsanguination (e.g., cavitary injury, long bone and pelvic fractures), traumatic brain injury, and cervical spine injury. Secondary outcomes were potentially mortal injuries (e.g., pneumothorax) and misplacement airway devices. Patients were grouped by whether arrest occurred prehospital/in-hospital. Univariate analysis was used to identify differences in injury patterns including multiple-trauma injury patterns. RESULTS Over a 9-year period, 80 decedents were included. Average age was 48.9 ± 21.7 years, 68% male, and an average ISS of 42.3 ± 16.3. The most common mechanism was motor vehicle accidents (67.5%) followed by pedestrian struck (15%). Of all decedents, 62 (77.5%) had traumatic arrest prehospital while 18 (22.5%) arrived with pulse. Between groups there were no significant differences in demographics including ISS. The most common mortal injuries were traumatic brain injury (40%), long bone fractures (25%), moderate/large hemoperitoneum (22.5%), and cervical spine injury (25%). Secondary outcomes included moderate/large pneumothorax (18.8%) and esophageal intubation rate of 5%. There were no significant differences in mortal or potentially mortal injuries, and no differences in multiple-trauma injury patterns. CONCLUSION Fatal blunt injury patterns do not vary between prehospital and in-hospital arrest decedents. High rates of pneumothorax and endotracheal tube misplacement should prompt mandatory chest decompression and confirmation of tube placement in all blunt arrest patients. LEVEL OF EVIDENCE Prognostic and Epidemiological; Level IV.
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Affiliation(s)
- Jeremy H Levin
- From the Division of Acute Care Surgery, Department of Surgery (J.H.L., A.M., P.M.H.), Department of Surgery (A.P.), Indiana University School of Medicine, Indiana University School of Medicine (V.O.), and Division of Emergency Radiology, Department of Radiology and Imaging Sciences (S.D.S.), Indiana University School of Medicine, Indianapolis, Indiana
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Wolthers SA, Jensen TW, Breindahl N, Milling L, Blomberg SN, Andersen LB, Mikkelsen S, Torp-Pedersen C, Christensen HC. Traumatic cardiac arrest - a nationwide Danish study. BMC Emerg Med 2023; 23:69. [PMID: 37340347 DOI: 10.1186/s12873-023-00839-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2022] [Accepted: 06/01/2023] [Indexed: 06/22/2023] Open
Abstract
BACKGROUND Cardiac arrest following trauma is a leading cause of death, mandating urgent treatment. This study aimed to investigate and compare the incidence, prognostic factors, and survival between patients suffering from traumatic cardiac arrest (TCA) and non-traumatic cardiac arrest (non-TCA). METHODS This cohort study included all patients suffering from out-of-hospital cardiac arrest in Denmark between 2016 and 2021. TCAs were identified in the prehospital medical record and linked to the out-of-hospital cardiac arrest registry. Descriptive and multivariable analyses were performed with 30-day survival as the primary outcome. RESULTS A total of 30,215 patients with out-of-hospital cardiac arrests were included. Among those, 984 (3.3%) were TCA. TCA patients were younger and predominantly male (77.5% vs 63.6%, p = < 0.01) compared to non-TCA patients. Return of spontaneous circulation occurred in 27.3% of cases vs 32.3% in non-TCA patients, p < 0.01, and 30-day survival was 7.3% vs 14.2%, p < 0.01. An initial shockable rhythm was associated with increased survival (aOR = 11.45, 95% CI [6.24 - 21.24] in TCA patients. When comparing TCA with non-TCA other trauma and penetrating trauma were associated with lower survival (aOR: 0.2, 95% CI [0.02-0.54] and aOR: 0.1, 95% CI [0.03 - 0.31], respectively. Non-TCA was associated with an aOR: 3.47, 95% CI [2.53 - 4,91]. CONCLUSION Survival from TCA is lower than in non-TCA. TCA has different predictors of outcome compared to non-TCA, illustrating the differences regarding the aetiologies of cardiac arrest. Presenting with an initial shockable cardiac rhythm might be associated with a favourable outcome in TCA.
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Affiliation(s)
- Signe Amalie Wolthers
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark.
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark.
| | - Theo Walther Jensen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Niklas Breindahl
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Department of Neonatal and Paediatric Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen, Denmark
| | - Louise Milling
- Department of Regional Health Research, Prehospital Research Unit, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Stig Nikolaj Blomberg
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Lars Bredevang Andersen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
| | - Søren Mikkelsen
- Department of Regional Health Research, Prehospital Research Unit, University of Southern Denmark, Odense, Denmark
- Department of Anaesthesiology and Intensive Care, Odense University Hospital, Odense, Denmark
| | - Christian Torp-Pedersen
- Department of Cardiology, Nordsjaellands Hospital, Hillerød, Denmark
- Department of Cardiology, Herlev Gentofte University Hospital, Gentofte, Denmark
- Department of Public Health, University of Copenhagen, Copenhagen, Denmark
| | - Helle Collatz Christensen
- Department of Clinical Medicine, Prehospital Center, Region Zealand, The University of Copenhagen, Ringstedgade 61, 13th floor, 4700, Naestved, Denmark
- Department of Clinical Medicine, University of Copenhagen, Copenhagen, Denmark
- Danish Clinical Quality Program (RKKP), National Clinical Registries, Copenhagen, Denmark
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Benhamed A, Mercier E, Freyssenge J, Heidet M, Gauss T, Canon V, Claustre C, Tazarourte K. Impact of the 2015 European guidelines for resuscitation on traumatic cardiac arrest outcomes and prehospital management: A French nationwide interrupted time-series analysis. Resuscitation 2023; 186:109763. [PMID: 36924821 DOI: 10.1016/j.resuscitation.2023.109763] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2022] [Revised: 02/19/2023] [Accepted: 03/03/2023] [Indexed: 03/17/2023]
Abstract
AIM To evaluate the impact of the 2015 European Resuscitation Council (ERC) guidelines on patient outcomes following traumatic cardiac arrest (TCA) and on advanced life support interventions carried out by physician-staffed ambulances. METHODS Data of TCA patients aged ≥18 years were extracted from the French nationwide cardiac arrest registry. A pre- (2011-2015) and a post-publication period (2016-2020) were defined. In the guidelines, a specific TCA management algorithm was introduced to prioritise the treatment of reversible causes. Its impact was evaluated using adjusted interrupted time series analysis. RESULTS 4,980 patients were treated (2,145 during the pre-publication period and 2,739 during the post-publication period). There was no significant change in the rates of prehospital ROSC (22.4% vs. 20.2%, p = 0.07 in the pre- and post- intervention respectively), survival (1.4% vs. 1.4%, p = 0.87) or good neurological outcome (71.4% vs. 66.7%, p = 0.93) or in the incidence of organ donation (1.6% vs. 1.3%, p = 0.50). There were nonsignificant changes in the adjusted temporal trend for ROSC (aOR 0.88; 95% CI [0.77; 1.00]), survival (aOR 1.34; 95% CI [0.83;2.17]), good neurological outcome (aOR 1.57; 95% CI [0.82;3.05]), and organ donation (aOR 1.06; 95% CI [0.71;1.60]). The use of intraosseous catheters (13.0% vs. 19.2%, p < 0.001), external haemorrhage control measures (23.9% vs. 64.8%, p < 0.001), bilateral chest decompression (13.7% vs. 16.5%, p = 0.009), and packed red cell transfusion (2.7% vs. 6.5%, p < 0.001) increased in the post-publication period. CONCLUSIONS Despite the increased frequency of trauma rescue interventions performed by on-scene physicians, no change in patient-centred outcomes was associated with the publication of the 2015 ERC guidelines in France.
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Affiliation(s)
- Axel Benhamed
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France; Centre de Recherche, CHU de Québec-Université Laval, Québec, Québec, Canada.
| | - Eric Mercier
- Centre de Recherche, CHU de Québec-Université Laval, Québec, Québec, Canada.
| | - Julie Freyssenge
- Réseau Urg'ARA, Lyon, France; INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.
| | - Mathieu Heidet
- SAMU 94, Hôpitaux Universitaires Henri Mondor, Assistance Publique- Hôpitaux de Paris (AP-HP), Paris, France.
| | - Tobias Gauss
- Anaesthesia Critical Care, Grenoble Alpes University Hospital, Grenoble, France.
| | - Valentine Canon
- Univ. Lille, CHU Lille, ULR 2694 - METRICS: Évaluation des Technologies de Santé et Des Pratiques Médicales, F-59000 Lille, France.
| | | | - Karim Tazarourte
- Service SAMU-Urgences, Centre Hospitalier Universitaire Édouard Herriot, Hospices Civils de Lyon, Lyon, France; INSERM U1290 (RESHAPE), Université Claude Bernard Lyon 1, Lyon, France.
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Škulec R. Year 2022 in review - Pre-hospital emergency care. ANESTEZIOLOGIE A INTENZIVNÍ MEDICÍNA 2022. [DOI: 10.36290/aim.2022.046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/18/2023]
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