Center for Emergency Medicine, Bach Mai Hospital, 78 Giai Phong road, Phuong Mai ward, Dong Da district, Hanoi, 100000, Vietnam.
Department of Emergency and Critical Care Medicine, Hanoi Medical University, Hanoi, Vietnam.
BMC Emerg Med. 2021 Nov 23;21(1):148. doi: 10.1186/s12873-021-00542-z.
Pre-hospital services are not well developed in Vietnam, especially the lack of a trauma system of care. Thus, the prognosis of traumatic out-of-hospital cardiac arrest (OHCA) might differ from that of other countries. Although the outcome in cardiac arrest following trauma is dismal, pre-hospital resuscitation efforts are not futile and seem worthwhile. Understanding the country-specific causes, risk, and prognosis of traumatic OHCA is important to reduce mortality in Vietnam. Therefore, this study aimed to investigate the survival rate from traumatic OHCA and to measure the critical components of the chain of survival following a traumatic OHCA in the country.
We performed a multicenter prospective observational study of patients (> 16 years) presenting with traumatic OHCA to three central hospitals throughout Vietnam from February 2014 to December 2018. We collected data on characteristics, management, and outcomes of patients, and compared these data between patients who died before hospital discharge and patients who survived to discharge from the hospital.
Of 111 eligible patients with traumatic OHCA, 92 (82.9%) were male and the mean age was 39.27 years (standard deviation: 16.38). Only 5.4% (6/111) survived to discharge from the hospital. Most cardiac arrests (62.2%; 69/111) occurred on the street or highway, 31.2% (29/93) were witnessed by bystanders, and 33.7% (32/95) were given cardiopulmonary resuscitation (CPR) by a bystander. Only 29 of 111 patients (26.1%) were taken by the emergency medical services (EMS), 27 of 30 patients (90%) received pre-hospital advanced airway management, and 29 of 53 patients (54.7%) were given resuscitation attempts by EMS or private ambulance. No significant difference between patients who died before hospital discharge and patients who survived to discharge from the hospital was found for bystander CPR (33.7%, 30/89 and 33.3%, 2/6, P > 0.999; respectively) and resuscitation attempts (56.3%, 27/48, and 40.0%, 2/5, P = 0.649; respectively).
In this study, patients with traumatic OHCA presented to the ED with a low rate of EMS utilization and low survival rates. The poor outcomes emphasize the need for increasing bystander first-aid, developing an organized trauma system of care, and developing a standard emergency first-aid program for both healthcare personnel and the community.
越南的院前服务发展不完善，特别是缺乏创伤护理体系。因此，创伤性院外心脏骤停（OHCA）的预后可能与其他国家不同。尽管创伤后心脏骤停的预后不佳，但院前复苏努力并非徒劳，似乎是值得的。了解越南创伤性 OHCA 的特定病因、风险和预后对于降低死亡率至关重要。因此，本研究旨在调查创伤性 OHCA 的生存率，并衡量该国创伤性 OHCA 后生存链的关键组成部分。
我们对 2014 年 2 月至 2018 年 12 月期间来自越南三个中心医院的 111 名创伤性 OHCA 患者进行了多中心前瞻性观察研究。我们收集了患者的特征、管理和结局数据，并比较了在出院前死亡的患者和出院后存活的患者之间的数据。
111 名符合条件的创伤性 OHCA 患者中，92 名（82.9%）为男性，平均年龄为 39.27 岁（标准差：16.38）。仅有 5.4%（6/111）出院后存活。大多数心脏骤停（62.2%；69/111）发生在街道或高速公路上，31.2%（29/93）由旁观者见证，33.7%（32/95）由旁观者进行心肺复苏（CPR）。只有 29 名患者（26.1%）由紧急医疗服务（EMS）送往医院，30 名患者中的 27 名（90%）接受了院前高级气道管理，53 名患者中的 29 名（54.7%）接受了 EMS 或私人救护车的复苏尝试。在出院前死亡的患者和出院后存活的患者之间，旁观者 CPR（33.7%，30/89 和 33.3%，2/6，P>0.999；分别）和复苏尝试（56.3%，27/48 和 40.0%，2/5，P=0.649；分别）没有显著差异。
在本研究中，创伤性 OHCA 患者到急诊科就诊时，EMS 使用率低，生存率低。不良结局强调需要增加旁观者急救，建立有组织的创伤护理体系，并为医疗保健人员和社区制定标准的急救方案。
