A novel scoring system using easily assessible predictors of return of spontaneous circulation and mortality in traumatic out-of-hospital cardiac arrest patients: A retrospective cohort study

I-Ming Kuo; Yi-Fu Chen; Chih-Ying Chien; Yi-Wen Hong; Shih-Ching Kang; Chih-Yuan Fu; Chih-Po Hsu; Chien-Hung Liao; Chi-Hsun Hsieh

doi:10.1016/j.ijsu.2022.106731

A novel scoring system using easily assessible predictors of return of spontaneous circulation and mortality in traumatic out-of-hospital cardiac arrest patients: A retrospective cohort study

Int J Surg. 2022 Aug:104:106731. doi: 10.1016/j.ijsu.2022.106731. Epub 2022 Jun 27.

Authors

I-Ming Kuo¹, Yi-Fu Chen², Chih-Ying Chien³, Yi-Wen Hong⁴, Shih-Ching Kang⁵, Chih-Yuan Fu⁵, Chih-Po Hsu⁵, Chien-Hung Liao⁵, Chi-Hsun Hsieh⁵

Affiliations

¹ Department of Surgery, Division of General Surgery, New Taipei Municipal TuCheng Hospital, Taiwan. Electronic address: m7017@cgmh.org.tw.
² Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.
³ Department of Surgery, Division of General Surgery, Chang Gung Memorial Hospital, Keelung, Taiwan; Institute of Emergency and Critical Care Medicine, National Yang Ming University, Taiwan.
⁴ Department of Surgery, Division of General Surgery, New Taipei Municipal TuCheng Hospital, Taiwan.
⁵ Department of Surgery, Division of Trauma and Emergency Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan.

PMID: 35772592
DOI: 10.1016/j.ijsu.2022.106731

Abstract

Background: An accident event may necessitate triage of multiple cases of traumatic out-of-hospital cardiac arrest (TOHCA). However, factors for prioritizing treatment among multiple TOHCA patients have not been established. This study aims to use easily assessible predictors of TOHCA outcomes to develop a triage scoring system.

Methods: Patients with TOHCA brought to our hospital by emergency medical services (EMS) were included for analysis to identify independent risk factors for poor outcomes. A scoring system was developed and validated internally and externally.

Results: Of the 401 included patients, 86 (21.4%) had return of spontaneous circulation (ROSC) after cardiopulmonary resuscitation (CPR) for 30 min (81 patients, 94.2%) or 45 min (86 patients, 100%). The emergency department (ED) mortality rate was 89.3% and overall in-hospital mortality rate was 99%. Univariate and multivariate analyses identified body temperature <33 °C (OR, 4.65; 95% CI, 1.37-15.86), obvious chest injury (OR, 2.11; 95% CI, 1.03-4.34), and presumable etiology of out-of-hospital cardiac arrest (OR, 1.73; 95% CI, 1.01-2.98) as significant independent risk factors for non-ROSC. The TOHCA score, calculated as 1 point per risk factor, correlated significantly with the rate of non-ROSC and ED mortality (TOHCA score 0, 1, 2, 3: non-ROSC rate, 63.0%, 80.4%, 90.8%, 100%, respectively; ED mortality rate, 79.5%, 91.5%, 96.1%, and 100% respectively). The results of internal and external validations show a similar trend in both non-ROSC and mortality in the ED with increasing score.

Conclusions: Termination of CPR for TOHCA after 45 min is reasonable; a 30-min resuscitation is acceptable in case of insufficient medical staff or resources. The TOHCA score may be able to be used with caution for triage.

Keywords: Priority; Return of spontaneous circulation; Scoring system; Traumatic cardiac arrest; Traumatic out-of-hospital cardiac arrest; Triage.

MeSH terms

Cardiopulmonary Resuscitation*
Emergency Medical Services*
Humans
Out-of-Hospital Cardiac Arrest*
Retrospective Studies
Return of Spontaneous Circulation