P. Hu1, R. Uhlich1, J. Kerby1, P. Bosarge1 1UAB,Acute Care Surgery/Surgery,Birmingham, AL, USA
Introduction:
Cardiac arrest following traumatic injury is almost universally fatal. Resuscitation strategies vary depending on mechanism of injury and length of arrest. While little evidence has been published to support its use following traumatic arrest, cardiopulmonary resuscitation (CPR) remains recommended as definitive therapy following injury. We sought to evaluate the outcomes of patients suffering traumatic arrest following CPR.
Methods:
All adult trauma patients that presented to an American College of Surgeons verified level I trauma center with cardiac arrest from June 1, 2014 to August 1, 2016 were identified. Patients in arrest secondary to obvious traumatic brain injury, anoxic brain injury, burn inhalation injury or any patient undergoing resuscitative thoracotomy were excluded. Data including mechanism of injury, demographics, duration of pre and in hospital CPR, initial cardiac rhythm, any identified procedures, blood product utilization, mortality data, and disposition from hospital were collected.
Results:
183 cases of CPR following traumatic arrest were identified. Of those, 87 were identified as meeting inclusion criteria. The majority of patients were male (78.2%) and the mean age was 47.1 years. Patients suffered mainly blunt injury (75.9%) compared to penetrating trauma (24.1%). 42 patients received CPR upon arrival in the emergency department, compared to 8 patients with isolated prehospital CPR and 37 patients receiving both. Mean prehospital CPR duration was 21.9 (0-60) minutes whereas mean isolated ED CPR time was 18.0 (0-80) minutes. Of those receiving CPR, return of spontaneous circulation (ROSC) occurred in only 8 patients (9.2%), none of whom received prehospital CPR. All underwent attempted operative intervention following ROSC. Mean CPR time was 3.6 (2-5) minutes with one lone survivor receiving 2 minutes of CPR while en route to the operating room. Overall, patients received on average 10.2 units of blood products. No patient presenting with asystole (39) and only one with PEA (35) survived to attempted operative intervention.
Conclusion:
For patients suffering traumatic cardiac arrest, short duration CPR may be beneficial as a bridge to immediate hemorrhage control. Prolonged periods of CPR without hemorrhage control are likely futile and unlikely to result in survival.
