RESPONSE AFTER OUT-OF-HOSPITAL CARDIAC-ARREST IN THE TRAUMA PATIENT SHOULD DETERMINE AEROMEDICAL TRANSPORT TO A TRAUMA CENTER

Objective: To evaluate whether aeromedical transport of trauma patient s who sustain an out-of-hospital cardiac arrest (OHCA) is justified, D esign: Retrospective chart review, Methods: We reviewed the outcome of 67 consecutive patients after OHCA with initial resuscitation who wer e transported to a Level I trauma center, Statistical analysis was use d to develop a predictive model for survival. Results: The overall sur vival was 19%, One of 28 patients with a second OHCA survived (p = 0.0 05), 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 rh ythm at the time of aeromedical team arrival were predictive of surviv al (R(2) = 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 rh ythm on arrival at the trauma center (41% vs, 0%); however, these para meters were not predictive of survival in the statistical model, The n eurologic outcome of the 13 survivors was good (preinjury state) in th ree cases, moderate disability (independent living) in three, severe d isability (needing assistance) in five, and persistent vegetative stat e in two, Regression analysis was unable to differentiate survivors wi th 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 t rauma center; (2) Revised Trauma Score and Injury Severity Score are u seful to predict survival; and (3) neurologic outcome is not accuratel y predicted by this model.