S98 Poster Presentations / Resuscitation 84S (2013) S8–S98

AP223

Traumatic cardiac arrest: When the going getstough, the tough . . .get together!

Wim Rens 1,∗, Alyssa Venema 3, Jelle Cloin 2, Paulvan Belkom 4, Sanne Kleinveld 3, Lies Schakelaar 2,Frank van der Heijden 3, Gerrit Jan Noordergraaf 5,Pieter van Driel 2

1 Royal Netherlands Army, Institute for Defence andPartnership Hospitals, Utrecht, The Netherlands2 St. Elisabeth Hospital, Department EmergencyMedicine, Tilburg, The Netherlands3 St. Elisabeth Hospital, Department DepartmentSurgery & Traumatology, Tilburg, The Netherlands4 St. Elisabeth Hospital, Department Intensive CareMedicine, Tilburg, The Netherlands5 St. Elisabeth Hospital, Department Anaesthesiology& Resuscitation, Tilburg, The Netherlands

Introduction: Outcome from traumatic cardiac arrest (TCA) ispoor although the mind set has been challenged.1 Recent experi-ence showed that while our core Trauma Team (cTT) and QuickResponse Team (QRT) are both organized and trained on a “role,competence, task” basis2 a TCA requires other goals.3 Our level 1trauma center admits unstable patients to a trauma bay with CT-scan with treatment table. We describe a methodology to achievepredetermined goals, including low no-flow fraction, early chestX-Ray and -tubes, controlled high-volume infusion. Our hypoth-esis was that integrating trauma and cardiac resuscitation teamsrequires specific work flow with an ABCDE strategy.

Methods and materials: The cTT tasks an anesthesiologist(A + B), surgeon (team leader, C), ER physician (facilitator), radiol-ogist and 2 trauma nurses. The QRT tasks a resident Internal Med(team leader), ER physician (A + B) and 2 Cardiac/ICU nurses.

We redefined roles and tasks to allow trauma managementwhile maintaining CPR quality as expressed by no-flow fraction,compression quality, cyclic evaluation and medication.4

Results: Based on initial trials, the trauma bay can be dividedinto patient right (trauma) and left (resuscitation) areas, integratingcTT and QRT but separating roles. The “A + B” role can be rele-gated to the ER resident, freeing the anaesthesiologist for invasiveaccess and monitoring tasks. The surgeon is free for rapid B + Cinterventions, and have a dedicated nurse. The internal med res-ident retains responsibility for monitoring and defibrillation, cyclicevaluations, resuscitation medication and volume management, inconjunction with the ER physician who is given the overall lead.This approach is similar to that used in Role 3 MNMU Hospital,Kandahar Afghanistan.

Key quality points e.g. no-flow fraction <0.2; 2 min cyclic rhythmevaluation; FAST ≤5 min of arrival; timely adrenaline and ade-quate volume (blood) infusion; if indicated chest drain(s) ≤7 minall improved. Unannounced cases with video-monitoring will allowfurther tuning and generalisation of this model.

Conclusion: While preliminary, role, task end competencedriven human factors in traumatic cardiac arrest may offer a win-dow to improved TCA success, as well as increased satisfaction incaregivers.

References

1. Leis CC, et al. J Trauma Acute Care Surg 2012;74:634–8.2. Cooper S, Wakelam A. Resuscitation 1999;42:27–45.3. Lockey DJ, et al. Resuscitation 2013;84:738–42.4. Cooper S, et al. Resuscitation 2010;81:446–52.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.248

AP224

Base deficit delta as a predictor model ofoutcome in traumatic patients

Esteban Garcia Padilla, Andres Felipe GarciaLondono ∗, Juan Jose Zancajo Torrecilla, FernandoMartinez Lopez, Carmen Colilles Calvet, CristianHernandez Delgado

Sabadell Hospital, Sabadell, Barcelona/cataluna,Spain

Background and goal of study: Comparison of survival prob-ability scores BISS and TRISS as a predictor model of outcome intraumatic patients.

Materials and methods: Prospective Study including traumaticpatients admitted in the hospital of Sabadell from November 2008to November 2010. The patients included in the study had aninjury severe enough to required intensive care unit admission.118 patients were included, the revised trauma score (RTS), injuryseverity score (ISS) and trauma injury severity score (TRISS) wascalculated at admission and then a blood sample was taken duringthe first hour of attention in the emergency department, inten-sive care or the operation room in order to determinate the basedeficit, We consider the base deficit normal range between −2and 2 mmol/L. the a comparison of the base deficit delta betweensurvivers and no survivers was done. We calculate the relationbetween the base deficit delta and the ISS, RTS and TRISS in orderto compare our BISS and TRISS with the original education andadjust the new coefficient to our patients. To compare the medi-ans values we used the wilcoxon/Kruskal/Wallis test. To calculatethe new coefficient of our population we used the stepwise logisticregression for the BISS and TRISS.

Results and discussion: From November 2008 to November2010 the hospital of Sabadell admitted 354 traumatic patients. 167of these patients required ICU admission, of those admitted in theICU we determinate the base deficit to 118 patients. The base deficitshows to be higher in the no survivor group (5.35) compared withthe survivor group (2.25) (P = 0.0157). The base deficit delta corre-lates with a low RTS, high ISS and low survive probability accordingto the original survival model of the TRISS and BISS coefficientsextracted from the MTOS data base. The base deficit delta correlatessignificantly with the mortality (Chi square 5.8625 P = 0.015).

Conclusion(s): BISS model predicts the outcome in traumaticpatients as well as the TRISS model does, its more objective and lesscomplicated to obtain. Because of this, the BISS model deserves arole in the evaluation of traumatic patients.

http://dx.doi.org/10.1016/j.resuscitation.2013.08.263