Survival of Out-of-Hospital Cardiac Arrest of Traumatic Patients who Received Medical Care from Emergency Medical Service System

Abstract

Background and Rationale: Thailand had the highest road traffic mortality in South-east Asia at 32.7 out of every 100,000 people. Chiang Mai was the 5^th ranking in Thailand. Emergency medical service system (EMS) can help reduce mortality of the injured patients outside hospitals. Objective: To study survival of out-of-hospital cardiac arrest (OHCA) of traumatic patients who received emergency medical care from EMS. Methodology: Retrospective descriptive study was conducted by collecting survival data from electronic medical record, forensic data and the Pan-Asian Resuscitation Outcome Study database from 1 January 2017 to 31 December 2018 recruiting OHCA traumatic patients receiving emergency med­ical care from EMS before treating at Maharaj Nakorn Chiang Mai Hospital. Results: Among 45 cardiac arrest traumatic patients, 75.5% were men with an average age of 30.7±14.8 years. The majority of inju­ries (80%) were traffic accidents, 91.0% had blunt injuries, 35.6% were pulseless electrical activity (PEA) and asystole and 62.2% unknown electrocardiograph. 4.4% achieved return of spontaneous circulation (ROSC) at scene, 55.6% achieved ROSC in a hospital emergency department, 22.2% survived at 24 hours, 15.5% survived at hospital discharge, and 11.1% survived with a good cerebral performance category (CPC 1-2). The most common injuries were multiple system injuries (51.1%), 21.7% of this group survived at 24 hours, 13.0% survived at hospital discharge, and 8.7% survived with a good cerebral performance category (CPC 1-2). Head injury was the most common single organ injury (35.6%), 18.8% survived at 24 hours, 18.8% survived at hospital discharge and 12.5% survived with a good cerebral performance category (CPC 1-2). Survival rate of head injury was highest. 8 patients who received chest compressions from bystanders achieved significantly higher ROSC than those who had not received chest compressions (87.5 and 48.6; p = 0.028). Patients underwent surgery (10 patients) survived at hospital discharge signifi­cantly higher than those without surgery (50.0 and 5.7; p = 0.003). Conclusion: Chest compression conducted by bystanders increased the likelihood of ROSC in the EMS OHCA injured patients. In addition, surgery also increased the chance of survival at hospital discharge of these patients.