Does the prognosis of cardiac arrest differ in trauma patients?*

David, Jean-Stéphane; Gueugniaud, Pierre‐Yves; Riou, Bruno; Pham, Emmanuel; Dubien, Pierre-Yves; Goldstein, Patrick; Freysz, M.; Petit, Paul

doi:10.1097/01.ccm.0000281859.61545.22

Cited by 55 publications

(32 citation statements)

References 33 publications

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“…These results also support our thesis that active CPR attempts after pre-hospital cardiac arrest may be as important in trauma patients as in medical patients, in particular if senior physicians are involved in patient's care [18]. Pickens et al showed a discharge rate of 7.6% in patients with trauma-related cardiac arrest, and further criticized recommendations that suggest not to perform CPR attempts in trauma patients [19].…”

Section: Resultssupporting

confidence: 79%

“…In the present study, trauma patients were 15 years younger compared with patients with cardiac causes, and the proportion of patients aged over 60 years was 45% compared with 72% younger than 60 years. This difference in age was also found by David et al [18]. The location of cardiac arrest also differed.…”

Section: Resultssupporting

confidence: 78%

“…In addition, David et al demonstrated in a study conducted in France, that aggressive and intensive therapy in these patients may be worthwhile [18]. The authors reported a ROSC rate of 34% and a hospital admission rate of 30%.…”

Section: Resultsmentioning

confidence: 99%

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

et al. 2011

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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.

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Section: Resultssupporting

confidence: 79%

Section: Resultssupporting

confidence: 78%

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

et al. 2011

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“…Many patients without severe injuries that have been triaged in the field by physicians are directly sent to the emergency department rather than to the Trauma Resuscitation Unit, which forms our study cohort. 24 …”

Section: Discussionmentioning

confidence: 99%

Comparative Effectiveness of Inhospital Trauma Resuscitation at a French Trauma Center and Matched Patients Treated in the United States

et al. 2013

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Objective The objective of this paper is to compare mortality outcomes between patients treated at a trauma center in France and matched patients in the United States. Summary Background Data Although trauma systems in France and the U.S. differ significantly in pre-hospital and in-hospital management, previous comparisons have been challenged by lack of comparable data. Methods Coarsened exact matching identified matching patients between a single center trauma database from Lyon, France and the National Trauma Data Bank (NTDB) of the U.S. Moderate to severely injured (ISS >8) adult patients (age ≥16) presenting alive to level-1 trauma centers from 2002–2005 with blunt or penetrating injuries were included. After matching patients, multivariate regression analyses were performed to determine difference in mortality between patients in Lyon and the NTDB. Results A total of 1,043 significantly injured patients presented to the Lyon center. Matching eligible patients with complete records were sought from 219,985 patients in the NTDB. The unadjusted odds of mortality at the Lyon center was 2.5 times higher than that of the NTDB (95% CI =2.18, 2.98). However, the Lyon center received patients with higher ISS, lower GCS and lower SBP (all p<0.001). After 1:1 matching 858 patient pairs were produced, and the odds of mortality became equivalent (OR= 1.3, 95% CI =0.91, 1.73). Similar results were found on multiple subset analyses. Conclusions Trauma patients admitted to a single French trauma center had an equal chance of survival compared to similarly injured patients treated at U.S. trauma centers.

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“…In practice, these patients are very seriously injured, and a few were already in cardiac arrest. As only around 2% of patients with traumatic cardiac arrest survive to discharge, many of these patients are likely to die 11. The true number of secondary transfers required therefore may be less than our estimate (figures 2 and 3).…”

Section: Resultsmentioning

confidence: 57%

Trauma systems: the potential impact of a trauma divert policy on a regional ambulance service

et al. 2011

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Does the prognosis of cardiac arrest differ in trauma patients?*

Cited by 55 publications

References 33 publications

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

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

Comparative Effectiveness of Inhospital Trauma Resuscitation at a French Trauma Center and Matched Patients Treated in the United States

Trauma systems: the potential impact of a trauma divert policy on a regional ambulance service

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