Pre-hospital Associated Factors of Survival in Traumatic Out-of-hospital Cardiac Arrests: An 11-Year Retrospective Cohort Study

Abstract

Introduction: Traumatic out-of-hospital cardiac arrest (TOHCA) presents significant public health challenges. The high accident rates and variability in prehospital management in Thailand further complicate TOHCA treatment. This study aimed to analyze prehospital prognostic factors of survival in TOHCA cases. Methods: This study is a retrospective cohort study utilizing data from the Information Technology of Emergency Medicine System (ITEMS) from January 2012 to December 2022. It included TOHCA patients who received prehospital care and were transported to the emergency department (ED). We used an exploratory approach, incorporating all prognostic variables into a multivariable logistic regression model. Results are presented as odds ratios (OR) with 95% confidence intervals (CIs) and p-values. Results: Over an 11-year period, 35, 724 patients with the mean age of 39.69±20.53 (range: 1–99) years were included in the final analysis (78.69% male). Of these, 6, 590 (18.45%) survived to hospital admission, while 29, 134 (81.55%) died in the ED. Prehospital management factors significantly increasing the likelihood of survival to hospital admission included stopping bleeding (OR=1.38, 95% CI=1.24–1.54, P<0.001), endotracheal intubation (ETT) (OR=2.09, 95% CI=1.74–2.50, P<0.001), intravenous fluid administration (OR=1.66, 95% CI=1.35–2.05, P<0.001), defibrillation (OR = 2.35, 95% CI=1.96–2.81, P<0.001), age (aOR = 0.99, 95% CI = 0.98–0.99, P < 0.001), closed fracture (aOR = 0.59, 95% CI = 0.53–0.66, P < 0.001), open fracture (aOR = 0.54, 95% CI = 0.48–0.61, P < 0.001), dislocation (aOR = 0.60, 95% CI = 0.45–0.81, P = 0.001), and on scene time <10 min (aOR = 0.63, 95% CI = 0.54–0.75, P < 0.001). Conclusion: To improve survival to hospital admission in TOHCA, several factors should be prioritized. These include administering intravenous fluid boluses, controlling external bleeding, delivering defibrillation when indicated, and performing ETT.