Abstract 17: Prehospital Interventions Associated with Survival from Traumatic Cardiac Arrest
Bibliographic record
Abstract
Traumatic cardiac arrest has traditionally been associated with a dismal prognosis, but emerging evidence suggests that survival may be better than expected. The objectives for this study were to 1) describe the contemporary management and outcomes of traumatic arrest; and 2) identify prehospital interventions associated with survival to hospital discharge. We completed a secondary analysis of traumatic arrest cases in the ROC Epistry-Trauma and PROPHET registries. Patients were included if they suffered a blunt or penetrating injury and received chest compressions in the field, regardless of whether they were ultimately transported to the hospital. Multivariable logistic regression analyses were used to generate odds ratios for survival to hospital discharge for the following interventions: advanced life support care, prehospital times, bag-mask ventilation, intubation, supraglottic airway, needle thoracostomy, hemorrhage control, and IV/IO fluids. The study population included 2248 traumatic arrest patients who were predominately young (mean 39 ± 20 years), males (78%), with blunt injuries (68%), without vital signs on EMS arrival (67%), and attended to by advanced life support paramedic crews (87%). A total of 193 patients (8.6%) survived to hospital discharge. More patients with blunt trauma (11%) compared to penetrating trauma (4.5%) survived. The majority (87%) of survivors had at least one vital sign on EMS arrival. Frequently performed procedures were bag-mask ventilation (86%), intubation (55%), and IV fluids (53%). All other procedures were performed in ≤ 15% of patients. Bag-mask ventilation (adjusted OR: 0.26, 95% CI 0.15, 0.44), intubation (adjusted OR: 0.45, 95% CI 0.265 to 0.764), and hemorrhage control (adjusted OR: 0.43, 95% CI 0.20 to 0.93) were all associated with a decreased odds of surviving to hospital discharge following blunt traumatic arrest. No other procedures significantly altered the odds of surviving to hospital discharge. We conclude that survival from traumatic arrest may be higher than previously thought, particularly in blunt trauma, and in those with at least one vital sign on EMS arrival. Frequently performed prehospital interventions were not associated with improved survival from traumatic arrest.
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How this classification was reachedexpand
Full frame machine prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. The Gemma side is a direct model label for every work in the frame, read from the title-only record. The Codex side is a classifier learned from the 10,348 direct Codex labels and calibrated to design-weighted sample rates; fields without enough sample support carry no Codex call. Candidate is the union of the two sides; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels.
Distilled classifier scores by category (both heads)
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.005 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.000 | 0.001 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.001 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.001 |
| Insufficient payload (model declined to judge) | 0.004 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one source (direct Gemma or distilled Codex), not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".