Top

Published in:

Open Access 01-12-2023 | Research

Traumatic cardiac arrest – a nationwide Danish study

Authors: Signe Amalie Wolthers, Theo Walther Jensen, Niklas Breindahl, Louise Milling, Stig Nikolaj Blomberg, Lars Bredevang Andersen, Søren Mikkelsen, Christian Torp-Pedersen, Helle Collatz Christensen

Published in: BMC Emergency Medicine | Issue 1/2023

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.

Available only for authorised users

Zwingmann J, Mehlhorn AT, Hammer T, Bayer J, Südkamp NP, Strohm PC. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care. 2012;16:R117. https://doi.org/10.1186/cc11410.CrossRefPubMedPubMedCentral

Leis CC, Hernández CC, Blanco MJG-O, Paterna PCR, Hernández R de E, Torres EC. Traumatic cardiac arrest. J Trauma Acute Care Surg. 2013;74:634–8. https://doi.org/10.1097/TA.0b013e31827d5d3c.CrossRefPubMed

Evans CCD, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, et al. Prehospital traumatic cardiac arrest: management and outcomes from the Resuscitation Outcomes Consortium Epistry-Trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81:285–93. https://doi.org/10.1097/TA.0000000000001070.CrossRefPubMedPubMedCentral

Pfeifer R, Tarkin IS, Rocos B, Pape H-C. Patterns of mortality and causes of death in polytrauma patients—Has anything changed? Injury. 2009;40:907–11. https://doi.org/10.1016/j.injury.2009.05.006.CrossRefPubMed

Zwingmann J, Lefering R, Feucht M, Südkamp NP, Strohm PC, Hammer T. Outcome and predictors for successful resuscitation in the emergency room of adult patients in traumatic cardiorespiratory arrest. Crit Care. 2016;20:282. https://doi.org/10.1186/s13054-016-1463-6.CrossRefPubMedPubMedCentral

Battistella FD. Field Triage of the Pulseless Trauma Patient. Arch Surg. 1999;134:742. https://doi.org/10.1001/archsurg.134.7.742.CrossRefPubMed

Ohlén D, Hedberg M, Martinsson P, von Oelreich E, Djärv T, Jonsson FM. Characteristics and outcome of traumatic cardiac arrest at a level 1 trauma centre over 10 years in Sweden. Scand J Trauma Resusc Emerg Med. 2022;30:54. https://doi.org/10.1186/s13049-022-01039-9.CrossRefPubMedPubMedCentral

Spasic I, Nenadic G. Clinical text data in machine learning: Systematic review. JMIR Med Informatics 2020;8. https://doi.org/10.2196/17984.

Benhamed A, Canon V, Mercier E, Heidet M, Gossiome A, Savary D, et al. Prehospital predictors for return of spontaneous circulation in traumatic cardiac arrest. J Trauma Acute Care Surg. 2022;92:553–60. https://doi.org/10.1097/TA.0000000000003474.CrossRefPubMed

10.

Minei JP, Schmicker RH, Kerby JD, Stiell IG, Schreiber MA, Bulger E, et al. Severe Traumatic Injury. Ann Surg. 2010;252:149–57. https://doi.org/10.1097/SLA.0b013e3181df0401.CrossRefPubMed

11.

Newgard CD, Koprowicz K, Wang H, Monnig A, Kerby JD, Sears GK, et al. Variation in the Type, Rate, and Selection of Patients for Out-of-hospital Airway Procedures Among Injured Children and Adults. Acad Emerg Med. 2009;16:1269–76. https://doi.org/10.1111/j.1553-2712.2009.00604.x.CrossRefPubMedPubMedCentral

12.

Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European Resuscitation Council Guidelines 2021: Cardiac arrest in special circumstances. Resuscitation. 2021;161:152–219. https://doi.org/10.1016/j.resuscitation.2021.02.011.CrossRefPubMed

13.

Beck B, Smith K, Mercier E, Cameron P. Clinical review of prehospital trauma deaths—The missing piece of the puzzle. Injury. 2017;48:971–2. https://doi.org/10.1016/j.injury.2017.02.024.CrossRefPubMed

14.

Jeppesen E, Iversen VV, Hansen IS, Reierth E, Wisborg T. Trauma research in the Nordic countries, 1995–2018 – a systematic review. Scand J Trauma Resusc Emerg Med. 2020;28:20. https://doi.org/10.1186/s13049-020-0703-6.CrossRefPubMedPubMedCentral

15.

Hansen J, Rasmussen LS, Steinmetz J. Prehospital triage of trauma patients before and after implementation of a regional triage guideline. Injury. 2022;53:54–60. https://doi.org/10.1016/j.injury.2021.10.011.CrossRefPubMed

16.

Lindskou TA, Mikkelsen S, Christensen EF, Hansen PA, Jørgensen G, Hendriksen OM, et al. The Danish prehospital emergency healthcare system and research possibilities. Scand J Trauma, Resusc Emerg Med. 2019;27:100. https://doi.org/10.1186/s13049-019-0676-5.CrossRefPubMed

17.

Statistics Denmark 2022. https://www.dst.dk/da/Statistik/emner/borgere/befolkning/befolkningstal (accessed November 7, 2022).

18.

Mikkelsen S, Lassen AT. The Danish prehospital system. Eur J Emerg Med. 2020;27:394–5. https://doi.org/10.1097/MEJ.0000000000000774.CrossRefPubMed

19.

Weile J, Nielsen K, Primdahl SC, Frederiksen CA, Laursen CB, Sloth E, et al. Trauma facilities in Denmark - A nationwide cross-sectional benchmark study of facilities and trauma care organisation. Scand J Trauma Resusc Emerg Med. 2018;26:1–8. https://doi.org/10.1186/s13049-018-0486-1.CrossRef

20.

Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest. Circulation 2015;132. https://doi.org/10.1161/CIR.0000000000000144.

21.

Jensen TW, Blomberg SN, Folke F, Mikkelsen S, Rostgaard-Knudsen M, Juelsgaard P, et al. The National Danish Cardiac Arrest Registry for Out-of-Hospital Cardiac Arrest – A Registry in Transformation. Clin Epidemiol. 2022;14:949–57. https://doi.org/10.2147/CLEP.S374788.CrossRefPubMedPubMedCentral

22.

Perkins GD, Jacobs IG, Nadkarni VM, Berg RA, Bhanji F, Biarent D, et al. Cardiac Arrest and Cardiopulmonary Resuscitation Outcome Reports: Update of the Utstein Resuscitation Registry Templates for Out-of-Hospital Cardiac Arrest. Resuscitation 2015;96. https://doi.org/10.1016/j.resuscitation.2014.11.002.

23.

Houwen T, Popal Z, de Bruijn MAN, Leemeyer A-MR, Peters JH, Terra M, et al. Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study. Injury. 2021;52:1117–22. https://doi.org/10.1016/j.injury.2021.02.088.CrossRefPubMed

24.

Escutnaire J, Genin M, Babykina E, Dumont C, Javaudin F, Baert V, et al. Traumatic cardiac arrest is associated with lower survival rate vs. medical cardiac arrest – Results from the French national registry. Resuscitation. 2018;131:48–54. https://doi.org/10.1016/j.resuscitation.2018.07.032.CrossRefPubMed

25.

Djarv T, Axelsson C, Herlitz J, Stromsoe A, Israelsson J, Claesson A. Traumatic cardiac arrest in Sweden 1990–2016 - a population-based national cohort study. Scand J Trauma Resusc Emerg Med. 2018;26:30. https://doi.org/10.1186/s13049-018-0500-7.CrossRefPubMedPubMedCentral

26.

Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis. Resuscitation. 2017;110:90–4. https://doi.org/10.1016/j.resuscitation.2016.11.001.CrossRefPubMed

27.

Newgard CD, Sears GK, Rea TD, Davis DP, Pirrallo RG, Callaway CW, et al. The Resuscitation Outcomes Consortium Epistry-Trauma: Design, development, and implementation of a North American Epidemiologic Prehospital Trauma Registry. Resuscitation. 2008;78:170–8. https://doi.org/10.1016/j.resuscitation.2008.01.029.CrossRefPubMedPubMedCentral

28.

Newgard CD, Meier EN, McKnight B, Drennan IR, Richardson D, Brasel K, et al. Understanding traumatic shock. J Trauma Acute Care Surg. 2015;78:342–51. https://doi.org/10.1097/TA.0000000000000478.CrossRefPubMedPubMedCentral

29.

Vianen NJ, Van Lieshout EMM, Maissan IM, Bramer WM, Den HD, Verhofstad MHJ, et al. Prehospital traumatic cardiac arrest: a systematic review and meta-analysis. Eur J Trauma Emerg Surg. 2022;48:3357–72. https://doi.org/10.1007/s00068-022-01941-y.CrossRefPubMedPubMedCentral

30.

Tran A, Fernando SM, Rochwerg B, Vaillancourt C, Inaba K, Kyeremanteng K, et al. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest – A systematic review and meta-analysis. Resuscitation. 2020;153:119–35. https://doi.org/10.1016/j.resuscitation.2020.05.052.CrossRefPubMed

31.

Barnard EBG, Sandbach DD, Nicholls TL, Wilson AW, Ercole A. Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest. Emerg Med J. 2019;36:333–9. https://doi.org/10.1136/emermed-2018-208165.CrossRefPubMed

32.

Seewald S, Wnent J, Gräsner J-T, Tjelmeland I, Fischer M, Bohn A, et al. Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries. BMC Emerg Med. 2022;22:158. https://doi.org/10.1186/s12873-022-00714-5.CrossRefPubMedPubMedCentral

33.

Luna GK, Pavlin EG, Kirkman T, Copass MK, Rice CL. Hemodynamic Effects of External Cardiac Massage in Trauma Shock. J Trauma Inj Infect Crit Care. 1989;29:1430–3. https://doi.org/10.1097/00005373-198910000-00022.CrossRef

34.

Soar J, Böttiger BW, Carli P, Couper K, Deakin CD, Djärv T, et al. European Resuscitation Council Guidelines 2021: Adult advanced life support. Resuscitation. 2021;161:115–51. https://doi.org/10.1016/j.resuscitation.2021.02.010.CrossRefPubMed

35.

Beck B, Tohira H, Bray JE, Straney L, Brown E, Inoue M, et al. Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014. Resuscitation. 2016;98:79–84. https://doi.org/10.1016/j.resuscitation.2015.10.015.CrossRefPubMed

36.

Jensen TW, Folke F, Andersen MP, Blomberg SN, Jørgensen AJ, Holgersen MG, et al. Socio-demographic characteristics of basic life support course participants in Denmark. Resuscitation. 2022;170:167–77. https://doi.org/10.1016/j.resuscitation.2021.11.006.CrossRefPubMed

37.

Jun GS, Kim JG, Choi HY, Kang GH, Kim W, Jang YS, et al. Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: A nationwide observational study. Clin Exp Emerg Med 2020;7:14–20. https://doi.org/10.15441/ceem.19.057.

38.

Naito H, Yumoto T, Yorifuji T, Nojima T, Yamamoto H, Yamada T, et al. Association between emergency medical service transport time and survival in patients with traumatic cardiac arrest: a Nationwide retrospective observational study. BMC Emerg Med. 2021;21:104. https://doi.org/10.1186/s12873-021-00499-z.CrossRefPubMedPubMedCentral

39.

Thomsen AH, Hougen HP, Villesen P, Brink O, Leth PM. Sharp Force Homicide in Denmark 1992–2016. J Forensic Sci. 2020;65:833–9. https://doi.org/10.1111/1556-4029.14244.CrossRefPubMed

Title: Traumatic cardiac arrest – a nationwide Danish study
Authors: Signe Amalie Wolthers
Theo Walther Jensen
Niklas Breindahl
Louise Milling
Stig Nikolaj Blomberg
Lars Bredevang Andersen
Søren Mikkelsen
Christian Torp-Pedersen
Helle Collatz Christensen
Publication date: 01-12-2023
Publisher: BioMed Central
Published in: BMC Emergency Medicine / Issue 1/2023
Electronic ISSN: 1471-227X
DOI: https://doi.org/10.1186/s12873-023-00839-1

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Traumatic cardiac arrest – a nationwide Danish study

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

Please log in to get access to this content

Other articles of this Issue 1/2023

Rethinking non-urgent EMS conveyance to ED during night-time - a pilot study in Southwest Finland

Evaluation of video review tools for assessing non-technical skills in emergency department resuscitation teams: a systematic review

War-related traumatic brain injuries during the Syrian armed conflict in Damascus 2014–2017: a cohort study and a literature review

Decision on non-conveyance of patients suspected of COVID-19 in a novel arrangement with assessment visits by paramedics at home

Red cell distribution width and mortality in older patients with frailty in the emergency department

Characteristics of rib fracture patients who require chest computed tomography in the emergency department