Emergency medical dispatch recognition, clinical intervention and outcome of patients in cardiac arrest from major trauma – an observational study
de Coverly, Richard
Lyon, Richard M.
Objectives The aim of this study is to describe the demographics of reported traumatic cardiac arrest (TCA) victims, pre-hospital resuscitation and survival to hospital rate. Setting Helicopter Emergency Medical Service in southeast 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 01/07/2016 – 31/12/2016 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, pre-hospital 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 pre-hospital medical intervention (defined as emergency anaesthesia, thoracostomy, blood product transfusion or resuscitative thoracotomy). Of the 61 patients in actual TCA, 10 (16%) achieved ROSC. 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 pre-hospital 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.