Predictors of sust
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
