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The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry
  1. Ed B G Barnard1,2,
  2. P A F Hunt1,3,
  3. P E H Lewis1,4 and
  4. J E Smith1,5
  1. 1Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine (Research & Academia), Birmingham, UK
  2. 2Department of Seconded Medical Officers, Institute of Naval Medicine, Gosport, Hampshire, UK
  3. 3Emergency Department, James Cook University Hospital, Middlesbrough, UK
  4. 4Emergency Department, Frimley Park Hospital, Frimley, Surrey, UK
  5. 5Emergency Department, Derriford Hospital, Plymouth, UK
  1. Correspondence to Ed B G Barnard, Academic Department of Military Emergency Medicine, Royal Centre for Defence Medicine, Institute of Research and Development, Birmingham B15 2SQ, UK; ukbarnard{at}gmail.com

Abstract

Background The UK military was continuously engaged in armed conflict in Iraq and Afghanistan between 2003 and 2014, resulting in 629 UK fatalities. Traumatic cardiac arrest (TCA) is a precursor to traumatic death, but data on military outcomes are limited. In order to better inform military treatment protocols, the aim of this study was to define the epidemiology of TCA in the military population with a particular focus on survival rates and injury patterns.

Methods A retrospective database analysis of the UK Joint Theatre Trauma Registry was undertaken. Patients who were transported to a UK deployed hospital between 2003 and 2014 and suffered TCA were included. Those patients injured by asphyxiation, electrocution, burns without other significant trauma and drowning were excluded. Data included mechanism of injury, Injury Severity Score (ISS), Abbreviated Injury Scale (AIS) for each body region and survival to deployed (Role 3) field hospital discharge.

Results 424 TCA patients were identified during the study period; median age was 23 years, with a median ISS of 45. The most common mechanism of injury was explosive (55.7%), followed by gunshot wound (38.9%), road traffic collision (3.5%), crush (1.7%) and fall (0.2%). 45 patients (10.6% (95% CI 8.0% to 13.9%)) survived to deployed (Role 3) hospital discharge. The most prevalent body region with a severe to maximum AIS injury was the head, followed by the lower limbs, thorax and abdomen. Haemorrhage secondary to abdominal and lower limb injury was associated with survival; traumatic brain injury was associated with death.

Conclusions This study has shown that short-term survival from TCA in a military population is 10.6%. With appropriate and aggressive early management, although unlikely, survival is still potentially possible in military patients who suffer traumatic cardiac arrest.

  • traumatic cardiac arrest
  • rauma
  • epidemiology
  • military

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Footnotes

  • Contributors The study was conceived by PAFH and JES. Literature searches were undertaken by EB, PAFH and PEHL. Data analysis was completed by EB and PAFH, and data interpretation by EB, PAFH and JES. The first draft was written by PAFH, and subsequent revisions were made by EB, PEHL and JES. All authors made critical revisions and approved the final manuscript for publication.

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Data sharing statement Data were obtained from the UK Joint Theatre Trauma Registry.

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