Predicto
Predictors of sustained return of spontaneous
circulation in patients with blunt traumatic out-of-hospital cardiac arrest in
Taiwan
Chao-Jui Li1,#, Yuan-Jhen
Syue2,#, Chien-Hung Lee3, Chia-Te Kung1, Chu-Chung
Chou4,5, Chin-Fu Chang 4and Yan-Ren Lin 4,5,6*
1 Department of
Emergency Medicine, Kaohsiung Chang Gung Memorial Hospital and Chang Gung
University College of Medicine, Kaohsiung, Taiwan, 2 Department of
Anesthesiology, Kaohsiung Chang Gung Memorial Hospital and Chang Gung
University College of Medicine, Kaohsiung, Taiwan, 3 Department of
Public Health, Kaohsiung Medical University, Taiwan, 4 Department of
Emergency Medicine, Changhua Christian Hospital, Changhua, Taiwan, 5 Institute
of Medicine, Chungshan Medical University, Taichung, Taiwan, 6 Department
of Biological Science and Technology and Institute of Biochemical Engineering,
National Chiao Tung University, Hsinchu, Taiwan
#Contribution equally, *Corresponding Author: Yan-Ren Lin, M.D. E-mail: [email protected]
Abstract: [Background] Patients with traumatic out-of-hospital cardiac arrest
(OHCA) have very poor outcomes, with survival rate ranging from only 0% to
7.5%. The aim of this study was to evaluate the predictors of achieving
sustained return of spontaneous circulation (ROSC) in adults during the early
resuscitation period. [Materials and Methods] This retrospective study
comprised 202 patients with traumatic OHCA in Taiwan. Demographics including
pre-hospital information and in-hospital treatment events were evaluated.
Variables were compared between patients who achieved sustained ROSC and those
who did not to determine possible predictors of outcome. Stepwise logistic
regression analysis was further used to select independent predictors.
Time-related survival analysis (Kaplan-Meier) was used to analyze the
likelihood of survival in patients who received different durations of
in-hospital advanced life support (ALS). [Results] The head and neck (52.5%)
were the most common sites of injury, and there were 29.7% patients developed
cardiac arrest with hypovolemia. The two most important variables associated
with achieving sustained ROSC were initial cardiac rhythm presenting as
pulseless electrical activity (PEA) (before and after adjust the presence of
hypovolemia: OR 6.7, 95% CI 2.0~22.3 and OR 6.7, 95% 2.0~22.4) and
administration of fluid totaling > 1500ml during the first 30 min of
in-hospital care (before and after adjust for the presence of hypovolemia: OR
4.7, 95% CI 2.2~10.1 and OR 4.8, 95% CI 2.2~10.3). [Discussions] Sustained ROSC
was more frequently achieved in patients who had initial cardiac rhythm
presenting with PEA and received > 1500 ml of fluid during the first 30 min
of in-hospital care. Sustained ROSC was difficult to achieve when in-hospital
ALS prolonged.
[Chao-Jui Li, Yuan-Jhen Syue, Chien-Hung
Lee, Chia-Te Kung, Chu-Chung Chou, Chin-Fu Chang and Yan-Ren
Lin. Predictors of sustained return of spontaneous circulation in
patients with blunt traumatic out-of-hospital cardiac arrest in Taiwan. Life
Sci J 2013;10(1):3484-3491]. (ISSN: 1097-8135). http://www.lifesciencesite.com. 440
Keywords cardiac arrest, traumatic OHCA, predictors,
resuscitation, Taiwan Full Text 440
