Surviving traumatic cardiac arrest: Identification of factors associated with survival.

INTRODUCTION: The endpoint of resuscitative interventions after traumatic injury resulting in cardiopulmonary arrest varies across institutions and even among providers. The purpose of this study was to examine survival characteristics in patients suffering torso trauma with no recorded vital signs (VS) in the emergency department (ED). METHODS: The National Trauma Data Bank was analyzed from 2007 to 2015. Inclusion criteria were patients with blunt and penetrating torso trauma without VS in the ED. Patients with head injuries, transfers from other hospitals, or those with missing values were excluded. The characteristics of survivors were evaluated, and statistical analyses performed. RESULTS: A total of 24,191 torso trauma patients without VS were evaluated in the ED and 96.6% were declared dead upon arrival. There were 246 survivors (1%), and 73 (0.3%) were eventually discharged home. Of patients who responded to resuscitation (812), the survival rate was 30.3%. Injury severity score (ISS), penetrating mechanism (odds ratio [OR] 1.99), definitive chest (OR 1.59) and abdominal surgery (OR 1.49) were associated with improved survival. Discharge to home (or police custody) was associated with lower ISS (OR 0.975) and shorter ED time (OR 0.99). CONCLUSION: Over a recent nine-year period in the United States, nearly 25,000 trauma patients were treated at trauma centers despite lack of VS. Of these patients, only 73 were discharged home. A trauma center would have to attempt over one hundred resuscitations of traumatic arrests to save one patient, confirming previous reports that highlight a grave prognosis. This creates a dilemma in treatment for front line workers and physicians with resource utilization and consideration of safety of exposure, particularly in the face of COVID-19.

Severe neonatal outcomes associated with emergency cesarean section at term.

Objective: To describe the incidence of severe neonatal outcomes in infants delivered by emergency cesarean section (CS) at term and to identify risk factors predisposing to these outcomes.Methods: This was a retrospective study of women that underwent a term emergency CS at the Mater Hospital in Brisbane between January 2007 and April 2017. Neonatal outcomes was defined as a composite of Neonatal Intensive Care Unit (NICU) admission, severe acidosis, Apgar score ≤3 and 5 min, and death (intrapartum stillbirth and neonatal death).Results: The risk of adverse outcome was highest for infants born by emergency CS. They had lower median BW (3388 versus 3503 g, p < .001), were born later (40 versus 39 weeks, p = .02) and had higher odds of birth >41 + 0 weeks (aOR 1.34, 95% CI 1.187-1.52, p < .001) birth. Birth weight <5th centile was associated with a tripling and BW <10th centile a doubling of odds of the composite outcome. Indications for emergency cesarean births that had the highest odds for the severe composite outcomes were cord prolapse (aOR 3.06, 95% CI 1.87-5.01, p < .001), failed instrumental delivery (aOR 2.50, 95% CI 1.95-3.21, p < .001), and non-reassuring fetal status (NRFS) (aOR 2.39, 95% CI 2.13-2.69, p < .001).Conclusions: Emergency cesarean is associated with a greater risk of severe neonatal outcome; with low birth weight, an additional independent risk factor for poor condition at birth.