R.E.B.E.L.EM - July 23 - By Zaf Qasim
Paper: Tran A et al. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest – a systematic review and meta-analysis. Resuscitation 2020. PMID: 32531405
"Clinical Question: What are the prognostic associations of various pre- and intra-arrest factors associated with return of spontaneous circulation (ROSC) and survival in adult patients following a traumatic out-of-hospital cardiac arrest (OHCA)?
Author(s) Conclusion: “This review provides very low to moderate certainty evidence that pre- and intra-arrest prognostic factors following penetrating or blunt traumatic OHCA predict ROSC and survival. This evidence is primarily based on unadjusted data. Further well-designed studies with larger cohorts are warranted to test the adjusted prognostic ability of pre- and intra-arrest factors and guide therapeutic decision-making”
Clinical Take Home Point: In this systematic review and meta-analysis, there was a signal to improved survival from traumatic out-of-hospital arrest with the presence of cardiac motion on ultrasound and a shockable initial rhythm. The findings do need to be taken in the context of the overall poor statistical quality (primarily retrospective and observational) and the significant risk of bias of included studies. While this study, within these limitations, is a valiant attempt to clarify gaps in clinical care around an important pathophysiologic process, it is also a call to arms to improve future research efforts in identifying the best predictors of good outcomes in traumatic arrest."