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Open Access

Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review

Daniel Shi, Christie McLaren, Chris Evans
DOI: 10.1136/tsaco-2021-000817 Published 5 November 2021
Daniel Shi
1School of Medicine, Queen's University, Kingston, Ontario, Canada
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Christie McLaren
1School of Medicine, Queen's University, Kingston, Ontario, Canada
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Chris Evans
2Emergency Medicine, Queen's University, Kingston, Ontario, Canada
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Figures

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  • Figure 1
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    Figure 1

    PRISMA diagram. PRISMA, Preferred Reporting Items for Systematic Reviews and Meta-Analyses.

Tables

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  • Table 1

    Characteristics of included studies

    Study identificationDesignAge groupSample sizeSurvivors (n)Mortality (%)Blunt traumaPenetrating traumaOther/unknown trauma type
    Alanezi45 2004Prospective cohortMixed50296.04460
    Barnard4 2017Retrospective cohortMixed7055392.56011040
    Beck46 2016Retrospective cohortMixed1354999.3869226259
    Calkins34 2002Retrospective cohortPediatric25292.02500
    Capizzani35 2010Retrospective cohortPediatric30680.02109
    Chia47 2017Retrospective cohortMixed15543897.6NRNR1554
    Chiang etal48 2015Retrospective cohortAdult5142096.13880126
    Chien49 2016Retrospective cohortAdult396997.719711188
    David50 2007Retrospective cohortAdult268697.8NRNR268
    Deasy51 2012Retrospective cohortMixed21872898.7NRNR2187
    Di Bartolomeo19 2005Retrospective cohortAdult181289.018100
    Djarv52 2018Retrospective cohortMixed17746596.3NRNR1774
    Duchateau53 2017Retrospective cohortAdult881088.677110
    Evans5 2016Retrospective cohortMixed230014592.71547736270
    Falcone54 1995Retrospective cohortAdult320698.1285360
    Fisher 55 1999Retrospective cohortPediatric65198.56500
    Graesner56 2011Retrospective cohortMixed81422172.959752165
    Hillman57 2016Retrospective cohortPediatric27485.24716
    Huber-Wagner58 2007Retrospective cohortMixed75713082.8714430
    Keller37 2013Retrospective cohortMixed4483791.7NRNRNR
    Kleber23 2014Prospective cohortMixed711579.9401219
    Lawhon20 1995Retrospective cohortMixed47295.7NRNR47
    Lin59 2016Retrospective cohortPediatric3883891.2365230
    Love60 2016Retrospective cohortMixed237797.0165720
    Lundy61 2011Retrospective cohortMixed30912559.5NRNR309
    Molina62 2008Retrospective cohortMixed94891.50940
    Mollberg63 2011Retrospective cohortAdult294199.7902040
    Moore44 2011Prospective cohortMixedNR56NR551NR
    Moore64 2016Prospective cohortAdult170810693.88208880
    Murphy65 2010Retrospective cohortPediatric1692883.4151711
    Perron66 2001Retrospective cohortPediatric72918474.850581143
    Pickens67 2005Retrospective cohortMixed1841492.490940
    Powell68 2004Retrospective cohortMixed9596293.51151897
    Rabinovici69 2014Retrospective cohortMixed67986.617500
    Shimazu70 1983Retrospective cohortMixed267797.4217500
    Stratton71 1998Retrospective cohortMixed879999.93824970
    Tarmey43 2011Prospective cohortAdult52492.301735
    Vassallo72 2019Retrospective cohortPediatric129794.6110190
    Zwingmann73 2015Retrospective cohortPediatric1524371.714570
    Zwingmann21 2016Retrospective cohortMixed305264978.7NRNR3052
    • NR, not reported.

  • Table 2

    Neurological outcomes of included studies

    Study identificationNeurological scaleTime pointQualitative outcomes
    GoodModeratePoorVegetativeMissing
    Alanezi45 2004QualitativeDischarge10100
    Barnard4 2017GOSDischarge24*N/A9†N/A20
    Beck46 2016CPCDischarge6*N/A300
    Calkins34 2002QualitativeDischarge20000
    Capizzani35 2010QualitativeDischarge21300
    Chia47 2017CPCDischarge15*N/A23†N/A0
    Chiang48 2015CPCDischarge12*N/A8†N/A0
    Chien49 2016CPCDischarge3*N/A6†N/A0
    David50 2007CPCDischarge2*N/A4†N/A0
    Deasy51 2012GOS1 year022123
    Di Bartolomeo19 2005GOS4 years00200
    Djarv52 2018CPCDischarge/30 days1576037
    Duchateau53 2017CPCDischarge72100
    Evans5 2016GOSDischarge24615397
    Falcone54 1995QualitativeDischarge40200
    Fisher55 1999QualitativeDischarge00010
    Graesner56 2011GOSDischarge725348408
    Hillman57 2016QualitativeVariable10102
    Huber-Wagner58 2007GOSDischarge151315681
    Keller37 2013GOSVariable1222120
    Kleber23 2014GOSDischarge131010
    Lawhon20 1995QualitativeDischarge/3 years00110
    Lin59 2016PCPCDischarge1226‡N/AN/A0
    Love60 2016QualitativeDischarge40300
    Lundy61 2011QualitativeDischarge3608900
    Molina62 2008QualitativeDischarge80000
    Mollberg63 2011QualitativeDischarge00100
    Moore64 2011QualitativeDischarge469100
    Moore44 2016GOSDischarge72130174
    Murphy65 2010QualitativeDischarge163720
    Perron66 2001FIMDischarge177§0700
    Pickens67 2005QualitativeDischarge111020
    Powell68 2004QualitativeDischarge1565036
    Rabinovici69 2014QualitativeDischarge71100
    Shimazu70 1983Qualitative30 days post admission40201
    Stratton71 1998CPCDischarge31230
    Tarmey43 2011GOSDischarge40000
    Vassallo72 2019GOSDischarge/30 days22102
    Zwingmann73 2015GOSAfter resuscitation14136100
    Zwingmann21 2016GOSAfter resuscitation193201174810
    Total Favorable: 992Unfavorable: 630Missing: 546
    • *Reported as good or moderate.

    • †Reported as poor or vegetative.

    • ‡Reported as moderate, poor, or vegetative.

    • §Reported as good, moderate, or poor.

    • CPC, Cerebral Performance Categories; FIM, Functional Independence Measure; GOS, Glasgow Outcome Scale; N/A, not available; PCPC, Pediatric Cerebral Performance Categories.

  • Table 3

    Quality review of included studies

    Study identificationConfounding*Participant selection†Classification of interventions‡Deviation from intended interventions§Missing data¶Outcomes**Selective reporting††Overall bias
    Alanezi45 2004SeriousModerateLowModerateLowSeriousModerateSerious
    Barnard4 2017SeriousModerateLowModerateModerateModerateModerateSerious
    Beck46 2016ModerateModerateLowLowModerateModerateModerateModerate
    Calkins34 2002SeriousLowLowLowLowSeriousModerateSerious
    Capizzani35 2010ModerateLowLowLowLowSeriousModerateSerious
    Chia47 2017ModerateLowLowModerateLowModerateModerateModerate
    Chiang48 2015ModerateLowLowModerateLowModerateLowModerate
    Chien49 2016SeriousLowLowLowModerateModerateModerateSerious
    David50 2007ModerateLowLowModerateLowModerateModerateModerate
    Deasy51 2012ModerateLowLowLowSeriousModerateModerateSerious
    Di Bartolomeo19 2005SeriousLowLowLowLowModerateModerateSerious
    Djarv52 2018ModerateLowLowLowSeriousModerateModerateSerious
    Duchateau53 2017ModerateLowLowLowLowModerateModerateModerate
    Evans44 2016ModerateLowLowLowModerateModerateModerateModerate
    Falcone54 1995SeriousLowLowModerateLowSeriousModerateSerious
    Fisher55 1999SeriousLowLowModerateLowSeriousModerateSerious
    Graesner56 2011ModerateLowLowModerateModerateModerateModerateModerate
    Hillman57 2016SeriousModerateLowModerateSeriousSeriousModerateSerious
    Huber-Wagner58 2007ModerateModerateLowModerateSeriousModerateModerateSerious
    Keller37 2013SeriousSeriousLowLowSeriousModerateModerateSerious
    Kleber23 2014SeriousLowLowModerateLowModerateModerateSerious
    Lawhon20 1995SeriousLowLowLowLowSeriousModerateSerious
    Lin59 2016ModerateModerateLowLowLowModerateModerateModerate
    Love60 2016ModerateLowLowModerateLowSeriousModerateSerious
    Lundy61 2011ModerateModerateLowModerateLowModerateModerateModerate
    Molina62 2008SeriousLowLowLowLowSeriousModerateSerious
    Mollberg63 2011SeriousLowLowModerateLowSeriousModerateSerious
    Moore64 2011ModerateLowLowLowLowModerateModerateSerious
    Moore44 2016ModerateLowLowLowLowModerateModerateModerate
    Murphy65 2010SeriousLowLowLowLowSeriousModerateSerious
    Perron66 2001ModerateLowLowLowSeriousModerateSeriousSerious
    Pickens67 2005ModerateModerateLowLowLowModerateModerateModerate
    Powell68 2004SeriousSeriousLowLowLowModerateModerateSerious
    Rabinovici69 2014ModerateLowLowLowLowSeriousModerateSerious
    Shimazu70 1983SeriousModerateModerateLowLowSeriousModerateSerious
    Stratton71 1998ModerateLowLowLowLowModerateModerateModerate
    Tarmey43 2011SeriousLowLowModerateLowModerateModerateSerious
    Vassallo72 2019SeriousModerateLowLowModerateModerateModerateSerious
    Zwingmann73 2015ModerateSeriousLowLowLowModerateModerateSerious
    Zwingmann21 2016ModerateSeriousModerateModerateLowModerateModerateSerious
    • *Were confounding variables controlled for with statistical analysis (eg, multivariate analysis)? Did they determine these factors appropriately (eg, univariate analysis, references, subject matter expert, etc)?

    • †Were only survivors/non-vegetative participants assessed? Was any group excluded (eg, specific year of arrests, no rhythm on presentation, type of trauma, witnessed cardiac arrest only, etc)?

    • ‡Was the exposure (traumatic cardiac arrest) well defined before the study? Was there a method used to identify these cases?

    • §Were special methods used for resuscitation (eg, therapeutic hypothermia, thoracotomy)? If so, was it reported and appropriately accounted for?

    • ¶Were any patients lost to follow-up? Was any method used to account for this/any attempt made to recover from this? Was there a particular group of patients that were lost to follow-up?

    • **Was the exposure known to the person assessing neurological outcome? How were neurological outcomes assessed? Was it subjective/unclear (eg, physician-reported, self-reported, etc)? Was a standardized scale used and data reported for all categories (eg, Glasgow Outcome Scale)?

    • ††Was there a preregistered protocol with preplanned outcomes to report? Were only specific outcomes reported in full? Were the neurological outcomes dichotomized into “good” and “poor” instead of reporting for each category?

Supplementary Materials

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  • Supplementary data

    [tsaco-2021-000817supp001.pdf]

Additional Files

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  • Supplementary Data

    This web only file has been produced by the BMJ Publishing Group from an electronic file supplied by the author(s) and has not been edited for content.

    • Data supplement 1
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Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review
Daniel Shi, Christie McLaren, Chris Evans
Trauma Surg Acute Care Open Nov 2021, 6 (1) e000817; DOI: 10.1136/tsaco-2021-000817

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Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review
Daniel Shi, Christie McLaren, Chris Evans
Trauma Surg Acute Care Open Nov 2021, 6 (1) e000817; DOI: 10.1136/tsaco-2021-000817
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Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review
Daniel Shi, Christie McLaren, Chris Evans
Trauma Surgery & Acute Care Open Nov 2021, 6 (1) e000817; DOI: 10.1136/tsaco-2021-000817
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