Article Figures & Data
Figures
- Figure 1
Flow chart of patient selection. 42 patients with traumatic cardiac arrest (TCA) in the current study were selected from 402 patients with severe traumatic brain injury (sTBI) admitted to Stony Brook University Hospital from January 2011 to December 2018. Exclusion criteria were listed. The mean Glasgow Coma Scale (GCS) scores of the surviving and deceased patients with TCA were 5.3 and 3.2, respectively.
- Figure 2
Cardiac rhythms before initiation of cardiopulmonary resuscitation. The most common cardiac rhythm is asystole (38.1%), followed by pulseless electrical activity (PEA) (35.7%).
- Figure 3
Pupil diameter and reactivity in patients with traumatic brain injury with traumatic cardiac arrest are compared between survivors and non-survivors in four categories.
Tables
- Table 1
Demographics and clinical characteristics of reviewed patients
Demographics Age, mean±SD 44.5±20.2 Sex Female (%) 9 (21.4) Male (%) 33 (78.6) ISS, mean±SD 38.2±14.0 Head AIS score, mean±SD 4.2±1.1 GCS score, mean±SD 3.5±1.3 GCS motor score, mean±SD 1.4±0.9 Mechanism of injury (%) Fall 6 (14.3) Motor vehicle collision 12 (28.6) Pedestrian struck 15 (35.7) Motorcycle crash 9 (21.4) Airway management (%) Endotracheal intubation 30 (71.4) Bag mask ventilation 2 (4.8) Cardiac arrest location (%) On the field 27 (64.3) En route 10 (23.8) ED 5 (11.9) Arrest rhythm (%) Asystole 16 (38.1) PEA 15 (35.7) Ventricular arrhythmia 2 (4.8) Unknown 9 (21.4) Imaging findings (%) Subdural hematoma 11 (42.3) SAH 21 (80.7) Hypoxic injury 8 (30.8) Herniation 6 (23.1) Rotterdam score, mean 2.8±1.2 Neurosurgical interventions (%) Bolt 11 (26.2) EVD 5 (11.9) Decompressive craniectomy 2 (4.8) Cause of death (%) Cardiac arrest 27 (64.3) Brain death 7 (16.7) AIS, Abbreviated Injury Scale; ED, emergency department; EVD, external ventricular drain; GCS, Glasgow Coma Scale; ISS, Injury Severity Score; PEA, pulseless electric activity; SAH, subarachnoid hemorrhage.
- Table 2
Clinical characteristics of survivors
Patient number Age (range) MOI Admission GCS score (motor), ISS Time to ROSC, type of arrest Pupil reactivity Brain injuries Follow-up
(6 months–1 year)Modified Rankin score, GOS-E score 1 20s Motorcycle crash 6, 45 Unknown, PEA Bilateral reactivity Multicompartmental intracranial hemorrhage.
Epidural hematoma.
Effacement of suprasellar cisterns.Able to walk.
Neurologically intact.2, 8 2 20s Motor vehicle collision 3, 22 Unknown, unknown Non-reactive, constricted Left SAH with bifrontal contusions.
Cerebral edema.Able to walk.
Able to carry out ADLs.2, 7 3 10s Pedestrian struck 3, 33 Unknown,
PEABilateral reactivity Diffuse SAH.
Cerebral edema.
Sulcal effacement.
Basilar cisterns effacement.Requires total assistance for ADLs.
Dependent on tracheotomy and gastric tube.5, 3 4 60s Pedestrian struck 8, 26 4 min, PEA Bilateral reactivity Intracranial hemorrhage.
SAH.Able to carry out ADLs independently. 1, 6 5 50s Motorcycle crash 6, 42 2 min, PEA Bilateral reactivity Bilateral SAH. Able to walk with prosthesis.
Able to communicate.
Residual right eye vision loss.1, 5 6 50s Motor vehicle collision 8, 50 Unknown, asystole Bilateral reactivity SAH in posterior right frontal regions.
Contusions in anterior frontal lobe.Paraplegia but otherwise able to communicate. 4, 4 7 50s Motor vehicle collision 5, 17 Unknown, unknown Non-reactive, constricted Diffuse SAH bilaterally.
Intraventricular hemorrhage.Non-verbal but followed commands.
Quadriplegic.
Dependent on tracheotomy and gastric tube.4, 3 8 20s Pedestrian struck 3, 34 Unknown, PEA Bilateral reactivity Right-sided pneumocephalus.
Left frontal lobe hemorrhagic contusion.
Bilateral frontal SAH.Able to communicate.
Regained use of arms.
Dependent on tracheotomy and gastric tube.4, 4 ADLs, activities of daily living; GCS, Glasgow Coma Scale; GOS-E, Glasgow Outcome Scale-Extended; ISS, Injury Severity Score; MOI, mechanism of injury; PEA, pulseless electric activity; ROSC, return to spontaneous circulation; SAH, subarachnoid hemorrhage.
- Table 3
Comparisons between survivors and non-survivors of traumatic arrest after TBI
Survivors (n=8) Non-survivors (n=34) P value Age, mean±SD 38.6±18.7 45.8±20.8 0.286 Sex 0.784 Female (%) 2 (25) 7 (20.6) Male (%) 6 (75) 27 (79.4) ISS, mean±SD 33.6±11.6 39.3±14.4 0.306 Head AIS score, mean±SD 3.9±1.1 4.3±1.1 0.365 GCS score, mean±SD 5.3±2.1 3.2±0.5 0.020 GCS motor score, mean±SD 2.5±1.3 1.1±0.4 0.026 Pupil diameter and reactivity (%) 0.001 Bilateral reactivity 5 (62.5) 3 (8.8) Bilateral constriction and non-reactivity 2 (25) 3 (8.8) Bilateral dilation and non-reactivity 1 (12.5) 27 (79.4) Unilateral dilation and non-reactivity 0 1 (2.9) Positive FAST examination (%) 2 (66.7) 19 (70.4) 0.894 Airway management (%) 0.139 Intubation 7 (87.5) 23 (67.6) Bag ventilation 1 (12.5) 1 (2.9) Cardiac arrest location (%) 0.701 On the field 6 (75) 21 (61.8) En route 1 (12.5) 9 (26.5) ED 1 (12.5) 4 (11.8) Arrest rhythm (%) 0.378 Asystole 1 (12.5) 15 (44.1) PEA 5 (62.5) 10 (29.4) Ventricular arrhythmia 0 2 (5.8) Unknown 2 (25) 7 (20.6) Mechanism of injury (%) 0.625 Fall 0 6 (17.6) MVC 3 (37.5) 9 (26.5) Pedestrian vs auto 3 (37.5) 12 (35.3) Motorcycle crash 2 (25) 7 (20.6) Violence 0 1 (2.2) Imaging findings (%) Subdural hematoma 1 (12.5) 10 (55.6) 0.001 SAH 8 (100) 13 (72.2) 0.007 Hypoxic injury 2 (25) 6 (33.33) 0.029 Herniation 1 (12.5) 5 (27.8) 0.019 Rotterdam score, mean±SD 2.63±0.9 2.89±1.4 0.625 Interventions (%) ICP monitoring 7 (87.5) 4 (11.8) <0.001 EVD 3 (37.5) 2 (5.9) 0.060 Decompressive craniectomy 0 2 (5.9) 0.594 Bolded: p<0.05
AIS, Abbreviated Injury Scale; ED, emergency department; EVD, external ventricular drain; FAST, focused assessment with sonography for trauma; GCS, Glasgow Coma Scale; ICP, intracranial pressure; ISS, Injury Severity Score; MVC, motor vehicle collision; PEA, pulseless electric activity; SAH, subarachnoid hemorrhage; TBI, traumatic brain injury.
