Factores pronóstico y resultados intrahospitalarios de la parada cardiaca traumática atendida en un servicio de urgencias

espanolObjetivo. Identificar los factores pronostico a la llegada a urgencias y los resultados al alta hospitalaria de los pacientes en parada cardiaca traumatica (PCT), documentada por un servicio de emergencias medicas (SEM), con posterior recuperacion de la circulacion espontanea (RCE). Metodo. Estudio de cohorte multiproposito de pacientes con PCT recuperada atendidos en un servicio de urgencias (SU) de un hospital universitario de tercer nivel de 2003 a 2016. Se recogieron variables epidemiologicas, tipo y mecanismo del traumatismo, datos de la atencion extrahospitalaria y del SU. La variable de resultado fue la mortalidad global intrahospitalaria. Resultados. Se incluyeron 130 PCT, de los cuales 123 (94,6%) sufrieron un traumatismo cerrado y 65 (50%) tuvieron un accidente de trafico. La edad media fue de 39 (DE 16) anos y 96 (73,8%) fueron varones. Cincuenta pacientes (65%) presentaron asistolia y 42 (32,3%) actividad electrica sin pulso (AESP). Dieciseis (12,3%) sobrevivieron al alta, de los cuales 13 (81,3%) tuvieron recuperacion neurologica favorable. Un ritmo de asistolia en la primera atencion de extrahospitalaria (OR = 25; IC 95% 2,5-247; p = 0,006), las pupilas arreactivas a la llegada al hospital (OR = 13; IC 95% 2,0-79; p = 0,006), y una puntuacion > 25 de la Injury Severity Score (ISS) (OR = 13; IC 95% 1,8-94; p = 0,011) se asociaron de forma independiente con la mortalidad intrahospitalaria. Conclusion. En nuestra serie, la supervivencia intrahospitalaria de la PCT fue un 12% siendo la recuperacion neurologica favorable en ocho de cada diez vivos. El ritmo inicial en asistolia en la atencion extrahospitalaria, la pupilas arreactivas a la llegada al hospital y una puntuacion > 25 de ISS podrian implicar un mal pronostico. EnglishObjective. To identify prehospital and on-arrival factors associated with hospital outcome in patients with traumatic cardiac arrest (TCA) discharged with recovered spontaneous circulation from the emergency department. Material and methods. Multipurpose prospective cohort study of patients with TCA who recovered after treatment at a tertiary care hospital emergency department between 2003 and 2016. We gathered data on epidemiologic variables, type and cause of injuries, and prehospital and hospital emergency care. The outcome was overall hospital mortality. Results. A total of 130 TCA cases were included; 123 patients (94.6%) had received blunt trauma injuries and 65 (50%) had been in traffic accidents. The mean (SD) age was 39 (16) years, and 96 (73.8%) were male. Fifty patients (65%) were in asystole and 42 (32.3%) had pulseless electrical activity. Sixteen (12.3%) survived to be discharged; 13 of the survivors (81.3%) had recovered neurological activity. Factors that were independently associated with hospital mortality were asystole on arrival of first responders (odds ratio [OR], 25; 95% CI, 2.5–247; P=.006), nonreactive pupils on arrival at the hospital (OR, 13; 95% CI, 2.0–79; P=.006), and an Injury Severity Score over 25 (OR, 13; 95% CI, 1.8–94; P=.011). Conclusions. Twelve percent of patients in this cohort survived to discharge after TCA and 8 out of 10 of the surviving patients recovered neurologically. Asystole at start of prehospital care, nonreactive pupils on hospital arrival, and a severity score over 25 may indicate poor prognosis after TCA.