title: Response after out-of-hospital cardiac arrest in the trauma patient should determine aeromedical transport to a trauma center.
abstract: OBJECTIVE
  To evaluate whether aeromedical transport of trauma patients who sustain an out-of-hospital cardiac arrest (OHCA) is justified.
  
  
  METHODS
  Retrospective chart review.
  
  
  METHODS
  We reviewed the outcome of 67 consecutive patients after OHCA with initial resuscitation who were transported to a Level I trauma center. Statistical analysis was used to develop a predictive model for survival.
  
  
  RESULTS
  The overall survival was 19%. One of 28 patients with a second OHCA survived (p = 0.005). Logistic regression analysis demonstrated that the Revised Trauma Score at trauma center arrival (1.0 +/- 0.25, nonsurvivors vs. 5.15 +/- 0.86, survivors, p = 0.0001), Injury Severity Score (34.9 +/- 2.9, nonsurvivors vs. 21.3 +/- 4.1, p = 0.037) and a sinus-based cardiac rhythm at the time of aeromedical team arrival were predictive of survival (R2 = 0.57, p = 0.0001). Survivors were more likely to have been transported from an outside hospital (28% vs. 8% for scene runs), had a sinus rhythm on team arrival (42% vs. 3%), and maintained a sinus rhythm on arrival at the trauma center (41% vs. 0%); however, these parameters were not predictive of survival in the statistical model. The neurologic outcome of the 13 survivors was good (preinjury state) in three cases, moderate disability (independent living) in three, severe disability (needing assistance) in five, and persistent vegetative state in two. Regression analysis was unable to differentiate survivors with a good neurologic recovery from the rest of the patient population.
  
  
  CONCLUSIONS
  These results suggest that: (1) trauma patients who are resuscitated to a sinus rhythm after OHCA should be transported to a trauma center; (2) Revised Trauma Score and Injury Severity Score are useful to predict survival; and (3) neurologic outcome is not accurately predicted by this model.
authors.affiliation: Department of Surgery, Case Western Reserve University School of Medicine, Cleveland, Ohio, USA.
authors.forename: D A
authors.initials: DA
authors.lastname: Margolin
authors.forename: D J
authors.initials: DJ
authors.lastname: Johann
authors.forename: W F
authors.initials: WF
authors.lastname: Fallon
authors.forename: M A
authors.initials: MA
authors.lastname: Malangoni
mesh_terms: D017732:Air Ambulances; D001794:Blood Pressure; D006323:Heart Arrest / Q000401:mortality / Q000503:physiopathology / Q000628:therapy*; D006339:Heart Rate; D006801:Humans; D016015:Logistic Models; D012189:Retrospective Studies; D015996:Survival Rate