Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury

Department of Epidemiology and Preventive Medicine, Faculty of Medicine, Nursing and Health Sciences, Monash University, Melbourne, Vic., Australia.
Injury (Impact Factor: 2.14). 06/2006; 37(5):448-54. DOI: 10.1016/j.injury.2005.11.011
Source: PubMed


The use of guidelines regarding the termination or withholding of cardiopulmonary resuscitation (CPR) in traumatic cardiac arrest patients remains controversial. This study aimed to describe the outcomes for victims of penetrating and blunt trauma who received prehospital CPR.
We conducted a retrospective review of a statewide major trauma registry using data from 2001 to 2004. Subjects suffered penetrating or blunt trauma, received CPR in the field by paramedics and were transported to hospital. Demographics, vital signs, injury severity, prehospital time, length of stay and mortality data were collected and analysed.
Eighty-nine patients met inclusion criteria. Eighty percent of these were blunt trauma victims, with a mortality rate of 97%, while penetrating trauma patients had a mortality rate of 89%. The overall mortality rate was 95%. Sixty-six percent of patients had a length of stay of less than 1 day. Four patients survived to discharge, of which two were penetrating and two were blunt injuries. Hypoxia and electrical injury were probable associated causes of two cardiac arrests seen in survivors of blunt injury.
While only a small number of penetrating and blunt trauma patients receiving CPR survived to discharge, this therapy is not always futile. Prehospital emergency personnel need to be aware of possible hypoxic and electrical causes for cardiac arrest appearing in combination with traumatic injuries.

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Available from: Mark Christopher Fitzgerald, Mar 10, 2015
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    • "Shimazu et al. (1983), in a report on 267 patients with cardiopulmonary arrest after trauma, mentioned that patients with blunt multisystem truncal injuries are unsalvageable (1). While many authors still believe resuscitation in these patients as a futile effort, with no chance of success for complete neurological recovery (2-5), some recent reports have challenged this idea, and successful resuscitations even with complete recovery have been reported (6-8). "
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    ABSTRACT: The decision to stop or continue resuscitation in a patient with blunt trauma and cardiac arrest arriving pulseless to the hospital has always been controversial. While many authors still believe that it is a futile effort, with no chance of success for complete neurological recovery, some recent reports have challenged the idea. Here we report complete recovery of a severely injured patient following a motor vehicle accident who lost vital signs completely before arrival at our trauma center. No cardiac motion was detected on ultrasound examination on arrival. Emergency department thoracotomy, open cardiac massage, massive blood transfusion, damage control laparotomy with abdominal and pelvic packing, followed by angio-embolization of pelvic bleeding, and staged abdominal exploration were performed. This case is an example showing that resuscitation of patients with blunt trauma and cardiac arrest arriving pulseless to the hospital is not always futile.
    Full-text · Article · Dec 2013
    • "According to these guidelines, some treatment efforts to resuscitate BT-CPA patients seemed to be futile. However, it has been reported that some survivors, who were not to be resuscitated if they were evaluated according to the NAEMSP/ACSCOT guidelines,[31213] and these guidelines do not address the effectiveness or futility of BTT for BT-CPA. "
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    ABSTRACT: Blood transfusion therapy (BTT), which represents transplantation of living cells, poses several risks. Although BTT is necessary for trauma victims with hemorrhagic shock, it may be futile for patients with blunt traumatic cardiopulmonary arrest (BT-CPA). We retrospectively examined the medical records of consecutive patients with T-CPA. The study period was divided into two periods: The first from 1995-1998, when we used packed red cells (PRC) regardless of the return of spontaneous circulation (ROSC), and the second from 1999-2004, when we did not use PRC before ROSC. The rates of ROSC, admission to the ICU, and survival-to-discharge were compared between these two periods. We studied the records of 464 patients with BT-CPA (175 in the first period and 289 in the second period). Although the rates of ROSC and admission to the ICU were statistically higher in the first period, there was no statistical difference in the rate of survival-to-discharge between these two periods. In the first period, the rate of ROSC was statistically higher in the non-BTT group than the BTT group. However, for cases in which ROSC was performed and was successful, there were no statistical differences in the rate of admission and survival-to-discharge between the first and second group, and between the BTT and non-BTT group. Our retrospective consecutive study shows the possibility that BTT before ROSC for BT-CPA and a treatment strategy that includes this treatment improves the success rate of ROSC, but not the survival rate. BTT is thought to be futile as a treatment for BT-CPA before ROSC.
    No preview · Article · Mar 2013 · Journal of Emergencies Trauma and Shock
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    • "Control of bleeding and correction of intravascular volume are the hallmarks of conventional resuscitation after massive blood loss [14]. After cardiopulmonary resuscitation of trauma patients with cardiac arrest, the survival rates are only 0% to 5% [15,16]. Cardiac resuscitation (chest compression without ventilation) by bystanders is the preferable approach for resuscitation [17]. "
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