Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile

Willis, Claire; Cameron, Peter; Bernard, Stephen; Fitzgerald, Mark

doi:10.1016/j.injury.2005.11.011

Cited by 88 publications

(39 citation statements)

References 19 publications

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“…In traumatic cardiac arrest, CPR during transport and mechanical ventilation for bone marrow transplant recipients, even mortality rates of approximately 95% can lead to a conclusion that treatment is not futile [21][22][23] . Because the prevailing perceptions of prognosis in these scenarios are so dismal, the impact of any reports of success, however limited, may lead to a conclusion that refutes futility, whereas the same very low rates of success may lead to the opposite conclusion in less extreme settings (e.g., sepsis).…”

Section: Discussionmentioning

confidence: 99%

“…Another important factor in the inherently provisional nature of data analysis in this context is the potential for future improvement in patient outcomes. For example, the three studies claiming futility of CPR for traumatic cardiac arrest were published in 1993, 1995 and 2004 based on mortality rates of 100% [24][25][26] , whereas two of three studies refuting the claim that this treatment is futile, were published in 2006 and one in 2003 21,27,28 . Mortality rates in the latter three articles were 44% to 94%.…”

Section: Discussionmentioning

confidence: 99%

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The Empirical Basis for Determinations of Medical Futility

et al. 2010

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BACKGROUND: Decisions to limit treatment in critically ill patients often rely on publications that make claims of futility based on outcome data. Our objective was to systematically review the criteria for futility and the strength of empirical evidence across clinical studies that purport to support or refute claims of futility. METHODS: The MEDLINE database was searched for relevant articles published between1980 and 2008. Selected studies reported original outcome data in critically ill or cardiac arrest patients and claimed that these data can support or refute decisions to limit treatment in comparable patients. Two authors independently abstracted data on patient characteristics, intervention, outcomes, cost, and design. RESULTS: Forty seven studies supporting a claim of futility and 45 refuting it were reviewed. Median point estimate for adverse outcome in studies supporting claims of futility was 100% (range 75% to 100%); median lower 95% confidence limit was 91% (range 48% to 99%). Explicit thresholds for futility were missing in 88% of articles. The original criteria for quantitative futility were fulfilled by only 28% of data, and almost exclusively in studies of cardiopulmonary resuscitation (CPR) for cardiac arrest. Substantial statistical overlap was observed between data brought in support of futility claims and data brought to refute them. CONCLUSIONS: Most studies that purport to guide determinations of futility are based on insufficient data to provide statistical confidence for clinical decisionmaking. They usually lack explicit a priori thresholds for determination of futility. Many studies draw disparate conclusions based on statistically similar data. In most circumstances these problems preclude confident determinations of futility.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

The Empirical Basis for Determinations of Medical Futility

et al. 2010

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“…[1,2,6] A low diastolic blood pressure should be considered an ominous sign and increase the index of suspicion for the transport crew. Unlike earlier reports, we did not note a difference in ROSC associated with ECG rhythms.…”

Section: Discussionmentioning

confidence: 99%

Predictors of ROSC in witnessed aeromedical cardiac arrests

Rittenberger¹,

Hostler²,

Tobin³

et al. 2008

Resuscitation

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Introduction-Aeromedical agencies are used routinely to transport critically ill patients to specialty centers. The characteristics of patients suffering a cardiac arrest during transport by aeromedical flight personnel are not well documented. We completed a retrospective analysis of aeromedical patient care records in order to describe the pre-arrest characteristics and the return of spontaneous circulation (ROSC) in this subset of patients.Materials and Methods-A retrospective chart review of patients suffering cardiac arrest while being treated by a single aeromedical transport service between 1998 and 2000. Crew configurations were paramedic/nurse or paramedic/physician. Data were directly abstracted by the authors and descriptive data of patient demographics, vital signs and medical history were obtained. Data were separated into medical and traumatic arrests and analyzed by chi-square and t-test. Logistic regression analyses were performed to determine predictors of ROSC.Results-During the 24-month interval, 12,140 patient transports occurred. Of these, 134 cardiac arrests occurred (1.1%) and are reviewed. Of these, 57 were medical arrests and 76 were traumatic arrests. Nine medical arrests and 37 traumatic arrests were excluded as the patient was in cardiac arrest prior to crew arrival. In the medical arrest cohort, the presence of a peripheral IV prior to crew arrival and initial rhythm of arrest were associated with ROSC at destination. (p=0.05) In the traumatic arrest cohort, patients with lower diastolic blood pressures had a trend toward lower rates of ROSC. (p=0.06) Conclusion-Cardiac arrest during aeromedical transport is infrequent. Patients with poor IV access are less likely to experience ROSC should they experience a cardiac arrest. Patients with traumatic injury and diastolic hypotension may be less likely to survive cardiac arrest during transport.

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“…Por ello, algunos autores han recomendado no empezar la reanimación en los pacientes que son encontrados en PCR y en los que no se detecta un ritmo electrocardiográfico organizado 5 . Sin embargo, otros estudios han encontrado supervivientes en pacientes que cumplí-an los criterios anteriormente mencionados para no iniciar la RCP 2,4 , por lo que consideramos que la decisión de no iniciar la RCP debe ser tomada de modo individualizado.…”

Section: Discussionunclassified