Multiple cases of traumatic out-of-hospital cardiac arrest (TOHCA) may need to be triaged due to an accident. However, there are no proven parameters for prioritizing therapy among numerous TOHCA patients. For a study, researchers aimed to create a triage score system using easily assessable predictors of TOHCA outcomes.
Patients with TOHCA who were transported to the hospital by EMS were included in the study to determine independent risk factors for poor outcomes. Internally and externally, a grading system was devised and verified.
About 86 (21.4%) of the 401 patients included experienced a return of spontaneous circulation (ROSC) after 30 minutes (81 patients, 94.2%) or 45 minutes after cardiopulmonary resuscitation (CPR) (86 patients, 100%). The ED death rate was 89.3%, while the overall in-hospital mortality rate was 99%. 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 presumed etiology of out-of-hospital cardiac arrest (OR, 1.73; 95% CI, 1.01-2.98) were identified as significant independent risk factors for non-ROSC in univariate and multivariate analyses. The TOHCA score, computed as one point for each risk factor, was found to be strongly associated 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). Internal and external validation data demonstrate a similar trend in both non-ROSC and ED mortality with the rising score.
CPR for TOHCA should be stopped after 45 minutes; a 30-minute resuscitation is allowed in case of limited medical staff or resources. The TOHCA score might be used for triage with caution.