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Algorithm to Improve Resuscitation Outcomes in Patients With Traumatic Out-of-Hospital Cardiac Arrest

Hsin-Min Lee1, Chia-Ti Wang1, Chien-Chin Hsu1

  • 1Emergency Department, Chi-Mei Medical Center, Tainan, TWN.

Cureus
|April 21, 2022
PubMed

Insights

An emergency department algorithm improved outcomes for traumatic out-of-hospital cardiac arrest (TOHCA) patients. The algorithm increased return of spontaneous circulation (ROSC) rates by guiding interventions for venous impedance, hypovolemia, and hypoxia.

Area of Science:

  • Emergency Medicine
  • Cardiology
  • Trauma Surgery

Background:

  • Traumatic out-of-hospital cardiac arrest (TOHCA) presents significant resuscitation challenges in the emergency department (ED).
  • Existing approaches may not adequately address the complex, often multifactorial causes of TOHCA.
  • Optimizing interventions for TOHCA is critical for improving patient survival and outcomes.

Purpose of the Study:

  • To introduce and evaluate a novel algorithm designed to enhance resuscitation outcomes for TOHCA patients in the ED.
  • To retrospectively analyze patient data to identify factors influencing outcomes following TOHCA.
  • To compare resuscitation success rates before and after the implementation of the new algorithm.

Main Methods:

  • Implementation of a specialized algorithm in September 2018 for managing TOHCA patients.
  • The algorithm facilitates rapid identification of potential causes and recommends targeted interventions.
  • A retrospective chart review compared outcomes for TOHCA patients over a five-year period, encompassing pre- and post-algorithm implementation phases.

Main Results:

  • Significant increases observed in the utilization of ED interventions such as blood transfusion, central venous catheter placement, and thoracostomy post-algorithm implementation.
  • The rate of return of spontaneous circulation (ROSC) significantly improved (23.6% vs. 41.5%, P = 0.035).
  • Trends towards increased hospital admission and survival to discharge were noted, with significantly higher end-tidal CO2 levels in admitted patients (P = 0.001).

Conclusions:

  • The developed algorithm effectively prioritizes and addresses the primary treatable causes of TOHCA: impedance of venous return, hypovolemia, and hypoxia.
  • Increased implementation of algorithm-recommended ED interventions correlated with a higher rate of ROSC.
  • The algorithm shows promise in improving resuscitation success for patients with traumatic out-of-hospital cardiac arrest.
Abstract

Keywords:
algorithmmajor traumaoutcomeresuscitationtraumatic out-of-hospital cardiac arrest

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