Author, date and country | Patient group | Study type (level of evidence) | Outcomes | Key results | Study Weaknesses |
---|---|---|---|---|---|
Di Bartolomeo S, et al July 2009 Italy | 129 blunt traumatic cardiac arrest patients | Prospective cohort study | Patient characteristics, mechanism of injury, on scene CPR, ROSC and survival to discharge | There is no significant benefit in long-term survival for blunt TCA patients undergoing advanced life support interventions with HEMS versus basic life support interventions by ground EMS. | Small sample size; limited HEMS response; initial cardiac rhythms not recorded; ground transport group younger in age; unknown actual duration of TCA; lower frequency of CPR performed in ground transport group; increased number of providers on scene in HEMS group; physician on all flights |
Falcone R, et al. September 1995 USA | Injured patients requiring CPR before or during air medical transport | Retrospective chart review | Survival to hospital admission | Air medical transport for the injured patient without signs of life following prehospital intervention appears futile. | Retrospective; primarily a rural setting only; patients were primarily male; primarily blunt injured patients; differing initial heart rhythms at scene; data from 1990s; flight crew bias regarding survivability and calling time of death at scene. |
Gleeson A, et al. September 1998 UK | Adult patients who sustained a non-traumatic cardiac arrest | Retrospective cohort study | Survival to hospital admission and discharge | Interventions by a hospital based flying squad have only a small effect on overall survival of patients with out of hospital cardiac arrest who have been primarily treated by ambulance crews provided with semi-automatic defibrillators | Retrospective analysis; male predominance; only requested after EMS on scene and assessed patients condition; initial rhythm and responsiveness to defibrillation |
Margolin D, et al October 1996 USA | 67 patients with out of hospital traumatic cardiac arrest transported to a Level 1 trauma center | Retrospective cohort study | Survival rate, Trauma Score, Injury Severity Score, Sinus-based cardiac rhythm at arrival, and neurological outcomes | Trauma patients resuscitated to a normal sinus rhythm after OHCA should be transported to a trauma center; The revised trauma score and Injury Severity Scores do help predict survival retrospectively, however, neurological outcome cannot be predicted accurately by this model. | Retrospective; small sample size; majority of patients transported from outside hospital (vs scene); flight crews with very experienced staff (nurses >5 years critical care experience, physician on every flight); primarily blunt injury; data from 1990s |
Peters J, et al September 2015 Netherlands | 144 patients with traumatic cardiac arrest (TCA) having undergone thoracostomy performed by helicopter emergency services (HEMS) teams | Retrospective cohort study | Number and outcomes of TCA patients having undergone thoracostomy performed by HEMS | Outcomes of TCA in patients having undergone prehospital thoracostomy were poor. There was no objective way to identify tension pneumothorax and it is unclear whether or not unnecessary thoracic interventions could be avoided | Retrospective; external validity of study; bystander bias for arrest and recognition needed for 911 call; presumed medical cause of arrest excluded; short time-frame of case review. |
Ter Avest E, et al December 2018 UK | 263 patients with traumatic cardiac arrest who were attended to by a non-urban (Kent, Surrey and Sussex Air Ambulance trust) helicopter emergency medical services (HEMS) transport crew | Retrospective cohort study | Number of patients with ROSC at the scene, number and type of HEMS specific advanced interventions occurred and how they related to ROSC and number of patients who survived to hospital discharge | HEMS teams can perform significant interventions such as blood product administration and RSI which increase ROSC in traumatic arrest patients in addition to providing additional advanced interventions such as thoracostomies and thoracotomies. | Retrospective; small sample size; physician on all flights; incomplete outcome data; unable to formally identify casual relation between outcomes and HEMS interventions; ROSC as primary outcome as opposed to survival. |
Wright SW, et al January 1989 USA | Patients who experienced traumatic cardiac arrest before the arrival of the flight team | Retrospective chart review | Improved survivability | Physician intervention at the scene and rapid aeromedical transport are not likely to improve mortality after traumatic cardiac arrest. | Retrospective; primarily blunt injury; data from 1980s; male predominance |
Peters J, et al. September 2015 Netherlands | 144 patients with traumatic cardiac arrest (TCA) having undergone thoracostomy performed by helicopter emergency services (HEMS) teams | Retrospective cohort study | Number and outcomes of TCA patients having undergone thoracostomy performed by HEMS | Outcomes of TCA in patients having undergone prehospital thoracostomy were poor. | Retrospective; no objective way to identify tension pneumothorax in prehospital setting; incomplete documentation; too low of survival rate to evaluate post thoracotomy infections; physician staffed HEMS |