Monday, 1 February 2016

Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia

A new SPHPM study by the Australian Resuscitation Outcomes Consortium (Aus-ROC) has been published in Resuscitation this month, which revealed that despite increasing rates of bystander cardiopulmonary resuscitation (CPR) in traumatic out-of-hospital cardiac arrest (OHCA) incidents in Perth, survival was poor with only nine survivors in 18 years.

Research Fellow Dr Ben Beck together with colleagues at Aus-ROC and the Prehospital, Resuscitation and Emergency Care Research Unit at Curtin University utilised OHCA data from the St John Ambulance Western Australia service over an 18-year period to investigate temporal trends in the incidence, mechanism of injury and rates of bystander CPR and commencement of resuscitation by paramedics in traumatic OHCA.

“While many think that the resuscitation of traumatic OHCA patients is futile, there is emerging data from both civilian and military settings that survival with good neurological outcomes is possible,” Dr Beck said.

He said that there is very limited published data on outcomes from traumatic OHCA, as the majority of research attention is on the most common aetiology, known as medical cardiac arrest.

“In medical OHCA, the provision of bystander CPR continues to be one of the most important modifiable factors associated with survival. However, the evidence in support of chest compressions from traumatic OHCA patients is limited,” he said.

“Although we observed an increase in rates of bystander CPR and commencement of resuscitation by paramedics over time, survival from traumatic OHCA was rare with only nine survivors in 18 years,” Dr Beck said.

He also said that in these cases it’s important to remember that survival rates are low due to the severity of injuries, and that these patients are complex to manage and commonly present with polytrauma, or multiple injuries.

“The treatment of these patients, when practical, is to address what are known as potentially ‘reversible causes’, these are factors such as excessive haemorrhage leading to low blood volume or a progressive build-up of air in the pleural space, reducing the ability of the cardiovascular system to return blood to the heart,” he said.

Although survival was poor in this study, Dr Beck said that further work in traumatic OHCA is in progress.

“We are currently investigating which patients are most likely to benefit from the commencement of resuscitation by paramedics, and factors that are associated with increased changes of survival,” he said.

“There are also a number of interventions that are being trialled internationally in traumatic OHCA, such as REBOA (Resuscitative Endovascular Balloon Occlusion of the Aorta; a method of controlling haemorrhage), and it will be interesting to follow the outcomes of these studies,” Dr Beck said.

It is hoped that this collective body of research will inform paramedic clinical practice and may lead to decreased mortality from traumatic OHCA.

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