Characteristics and Outcomes of Traumatic Cardiac Arrests in the Pan-Asian Resuscitation Outcomes Study*

Abstract

Objective

Little is known about survival outcomes after traumatic cardiac arrest in Asia, or the association of Utstein factors with survival after traumatic cardiac arrests. This study aimed to describe the epidemiology and outcomes of traumatic cardiac arrests in Asia, and analyze Utstein factors associated with survival.

Methods

Traumatic cardiac arrest patients from 13 countries in the Pan-Asian Resuscitation Outcomes Study registry from 2009 to 2018 were analyzed. Multilevel logistic regression was performed to identify factors associated with the primary outcomes of survival to hospital discharge and favorable neurological outcome (Cerebral Performance Category (CPC) 1-2), and the secondary outcome of return of spontaneous circulation (ROSC).

Results

There were 207,455 out-of-hospital cardiac arrest cases, of which 13,631 (6.6%) were trauma patients aged 18 years and above with resuscitation attempted and who had survival outcomes reported. The median age was 57 years (interquartile range 39–73), 23.0% received bystander cardiopulmonary resuscitation (CPR), 1750 (12.8%) had ROSC, 461 (3.4%) survived to discharge, and 131 (1.0%) had CPC 1-2. Factors associated with higher rates of survival to discharge and favorable neurological outcome were arrests witnessed by emergency medical services or private ambulances (survival to discharge adjusted odds ratio (aOR) = 2.95, 95% confidence interval (CI) = 1.99–4.38; CPC 1-2 aOR = 2.57, 95% CI = 1.25–5.27), bystander CPR (survival to discharge aOR = 2.16; 95% CI 1.71–2.72; CPC 1-2 aOR = 4.98, 95% CI = 3.27–7.57), and initial shockable rhythm (survival to discharge aOR = 12.00; 95% CI = 6.80–21.17; CPC 1-2 aOR = 33.28, 95% CI = 11.39–97.23) or initial pulseless electrical activity (survival to discharge aOR = 3.98; 95% CI = 2.99–5.30; CPC 1-2 aOR = 5.67, 95% CI = 3.05–10.53) relative to asystole.

Conclusions

In traumatic cardiac arrest, early aggressive resuscitation may not be futile and bystander CPR may improve outcomes.

Acknowledgments

Pan-Asian Resuscitation Outcomes Study Clinical Research Network.

Participating site investigators: H Tanaka (Graduate School of EMS System, Kokushikan University, Tokyo, Japan); K Kajino (Kansai Medical University Hospital, Osaka, Japan); SD Shin (Department of Emergency Medicine, Seoul National University College of Medicine, Seoul, Korea); HW Ryoo (Department of Emergency Medicine, Kyungpook National University Hospital, Daegu, Korea); MHM Ma (Department of Emergency Medicine, National Taiwan University Hospital Yunlin Branch, Douliou, Taiwan); PCI Ko (Department of Emergency Medicine, National Taiwan University Hospital, Taipei, Taiwan); CW Kuo (Department of Emergency Medicine, Chang-Gung Memorial Hospital, Linkou, Taoyuan, Taiwan); P Khruekarnchana (Rajavithi Hospital, Bangkok, Thailand); Wong KD (Emergency Department, Hospital Pulau Pinang, Penang, Malaysia); NE Doctor (Sengkang General Hospital, Singapore); S Arulanandam (Emergency Medical Services Department, Singapore Civil Defence Force, Singapore); HN Gan (Changi General Hospital, Singapore); BSH Leong (National University Hospital, Singapore); SO Cheah (Urgent Care Clinic International, Singapore); WM Ng (Ng Teng Fong General Hospital, Singapore); DR Mao (Khoo Teck Puat Hospital, Singapore); YY Ng (Tan Tock Seng Hospital, Singapore); LP Tham (KK Women’s & Children’s Hospital, Singapore); M Vimal (GVK Emergency Management and Research Institute, Telangana, India); FJ Gaerlan (Southern Philippines Medical Center, Davao, Philippines); SA Zhou (Zhejiang Provincial People's Hospital, Zhejiang, China); M Khursheed (Emergency Department, National Institute of Cardiovascular Diseases, Karachi, Pakistan), DA Nguyen (Bach Mai Hospital, Hanoi, Vietnam); S AlQahtani (National Ambulance, Abu Dhabi, United Arab Emirates).

We would like to thank Ms Pin Pin Pek and the late Ms Susan Yap from the Health Services and Systems Research, Duke-NUS Medical School and Department of Emergency Medicine, Singapore General Hospital for coordinating the study. We would also like to thank Ms Patricia Tay from the Singapore Clinical Research Institute for her work as secretariat for the PAROS network.

Disclosure Statement

MEH Ong reports funding from the Zoll Medical Corporation for a study involving mechanical cardiopulmonary resuscitation devices; grants from the Laerdal Foundation, Laerdal Medical, and Ramsey Social Justice Foundation for funding of the Pan-Asian Resuscitation Outcomes Study; an advisory relationship with Global Healthcare SG, a commercial entity that manufactures cooling devices; and funding from Laerdal Medical on an observation program to their Community CPR Training Center Research Program in Norway. MEH Ong has a licensing agreement and patent filed (Application no: 13/047,348) with ZOLL Medical Corporation for a study titled “Method of predicting acute cardiopulmonary events and survivability of a patient”. He is the co-founder and scientific advisor of TIIM Healthcare, a commercial entity which develops real-time prediction and risk stratification solutions at triage. All other authors have no potentially competing interests to declare.

Data Sharing

Study variables, data dictionary, collection form, and protocol are shared on the study trial coordinating center’s webpage: https://www.scri.edu.sg/crn/pan-asian-resuscitation-outcomes-study-paros-clinical-research-network-crn/about-paros/. Data from the registry can only be shared among PAROS participating sites and members.

Additional information

Funding

The study was supported by grants from the National Medical Research Council (NMRC/CSA/0049/2013) and Laerdal Foundation (20040). The funders have no involvement in the study design, collection, analysis, and interpretation of data, nor do they have a role in the writing of the paper and decision to submit the paper for publication. Laerdal Foundation for Acute Medicine.