Introduction. Traumatic cardiac arrest (TCA) has very high mortality rates. Evidence on specific interventions are poor, pointing out the prompt treatment of reversible causes and reporting predictors of mortality.The level at which the bar of futility should be set is still undisclosed.
Objectives.To analyze clinical trajectories (CT) of TCA and identify patients in which maximize the efforts and optimize resource allocation.
Materials & methods.
Design:retrospective bi-center study. Patients were retrieved from Niguarda and Humanitas Hospital trauma registries.
Primary outcome:rate and trends of mortality.
Secondary outcomes:trauma severity,organ retrival and status at discharge.
Inclusion criteria:TCA at any moment of management. We identified 3 groups according to clinical trajectories. Pre- and In-hospital TCA, group 1(G1);pre-hospital TCA,group 2(G2); in-hospital TCA,group 3(G3).
G1-2-3 were compared with Anova or Fisher's exact test accordingly.
Results.
204 TCA were included, 67 in Group 1, 66 in Group 2, 71 in Group 3. G1 TCA received a more aggressive damage control (DC) approach and had higher Injury Severity Score due to more severe head and torso injuries. Mortality rate was 100% in G1, 89% ≤3 hours, vs 68% in G2, 22% ≤3 hours, and 84% in G3, 61% ≤3 hours.
40% of survivors in G2 were discharged to rehabilitation vs 10% in G3, with a lower rate of Glasgow Outcome Scale 5, 52% G2 vs 100% G3. In G3 80% went home vs 45% in G2. p<0.05 for all comparisons.
Conclusions.
Our results partially align with the literature. We disclosed the need for an in-depth reflection on continuous aggressive in-hospital DC in non-resolving TCAs from the field, G1, in which the efforts and resource usage did not lead to any advantage. Other CT, G2-3, may identify TCAs worthy of persistent efforts, looking at survival, organ donation rates and functional outcomes.
Figure 1. Clinical trajectories of TCA.
References PMID 36859355; 37162554; 35333932; 31926614
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