Article Text
Abstract
Objectives The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, prehospital resuscitation and survival to hospital rate.
Setting Helicopter Emergency Medical Service (HEMS) in south-east England, covering a resident population of 4.5 million and a transient population of up to 8 million people.
Participants Patients reported on the initial 999 call to be in suspected traumatic cardiac arrest between 1 July 2016 and 31 December 2016 within the trust’s geographical region were identified. The inclusion criteria were all cases of reported TCA on receipt of the initial emergency call. Patients were subsequently excluded if a medical cause of cardiac arrest was suspected.
Outcome measures Patient records were analysed for actual presence of cardiac arrest, prehospital resuscitation procedures undertaken and for survival to hospital rates.
Results 112 patients were reported to be in TCA on receipt of the 999/112 call. 51 (46%) were found not to be in TCA on arrival of emergency medical services. Of the ‘not in TCA cohort’, 34 (67%) received at least one advanced prehospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved return-of-spontaneous circulation. In 45 (88%) patients, the HEMS team escorted the patient to hospital.
Conclusion A significant proportion of patients reported to be in TCA on receipt of the emergency call are not in actual cardiac arrest but are critically unwell requiring advanced prehospital medical intervention. Early activation of an enhanced care team to a reported TCA call allows appropriate advanced resuscitation. Further research is warranted to determine which interventions contribute to improved TCA survival.
- trauma management
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Footnotes
Contributors CP and JJ were involved in data collation and analysis. Data analysis was reviewed by JW, JJ and RL. All authors contributed to the data review, preparation of the manuscript and approval of the manuscript prior to submission.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests CP, JJ, JW, RDC and RL are all employees of Kent, Surrey and Sussex Air Ambulance Trust.
Patient consent Not required.
Ethics approval This study met UK National Institute for Health Research criteria for a service evaluation. All the data utilised for this study was routinely collected as part of standard pre-hospital and hospital patient data collection. Formal ethical approval was therefore waived as criteria for service evaluation were met. The study was registered with the University of Surrey as a service evaluation.
Provenance and peer review Not commissioned; externally peer reviewed.
Data sharing statement All data generated or analysed during this study are included in this published article.