Cardiopulmonary resuscitation traumatic cardiac arrest - there are survivors. An analysis of two national emergency registries

Abstract

IntroductionCardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany.MethodsThis study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted.ResultsWithin the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome.ConclusionsOur present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged.

Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors

“…These predictors include the presence of bystander CPR and the arrest being witnessed by a bystander or EMS, both of which we showed to have no association with outcomes from traumatic OHCA. While bystander CPR rates in our region were higher than have been previously reported for traumatic OHCA,4 the utility of bystander CPR in traumatic cardiac arrest has been questioned7 19 and our results demonstrated that the presence of bystander CPR was not associated with achieving ROSC or survival to hospital in multivariable models. The presence of bystander CPR may also increase the likelihood of a paramedic attempting resuscitation in cases that are potentially futile.…”

“…Previous studies have used descriptive statistics to characterise a cohort of traumatic OHCA patients that survived to hospital4 or hospital discharge,13 or compared survivors and non-survivors 3. Pickens et al 5 noted no differences in demographics and the mechanism of injury between survivors and non-survivors.…”

Risk stratification of survival in injured patients with cardiopulmonary resuscitation within the first hour of arrival to trauma centre: retrospective analysis from the national trauma data bank

“…A recent report by Gräsner and colleagues analysed German registry data, which included 1903 patients with trauma and cardiac arrest at the scene where CPR was performed 16. This report demonstrated that 25% of the patients had a return of spontaneous heart rhythm on arrival to the hospital.…”

Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest

“…Different EMS organisations may explain in part the discordant survival rates for TCA between recent studies5 6 and studies from the USA 14 15. Data, such as those presented here, emanate from a physician-staffed EMS and show a better prognosis 5 6.…”