N. R. Manley1, J. Holley1,2, J. Martin2, T. Stavely1, M. Croce1, P. E. Fischer1 1University Of Tennessee Health Science Center,Surgery,Memphis, TENNESSEE, USA 2Memphis Fire Department,Memphis, TENNESSEE, USA
Introduction: Prehospital resuscitation of patients with blunt traumatic cardiac arrest (BTCA) is known to have extremely poor outcomes when success is considered hospital discharge. However, the results are unknown when survival is defined as hospital discharge or organ donation. Prehospital protocols must be adjusted to decrease futile resource utilization while not sacrificing potential survivors or donors, as one donor can potentially provide 7 organs. We sought to identify factors associated with survival (discharge or organ donation) of patients with BTCA.
Methods: All adult patients with BTCA transported by our city EMS for 2013-2015 were included. Data on demographics, prehospital resuscitation, prehospital injury assessment, hospital course and outcomes were collected and analyzed. Survival was considered either hospital discharge or consideration for organ donation.
Results: There were 61 patients with BTCA and overall survival was 5% (1 discharge, 2 organ donation). Two kidneys and one liver were successfully procured allowing 3 transplants. There was no difference in survivors regarding mean prehospital CPR time (25 vs 24 min) or initial cardiac rhythm. On prehospital assessment, 36 patients (59%) had documented head trauma and 2 survived (8%). 22 patients (36%) had torso trauma and none survived. All patients required extensive prehospital resources with an average ambulance service time of 103 minutes.
Conclusion: Prehospital resuscitation of BTCA patients with evidence of torso trauma appears futile and these patients should be declared in the field. However, BTCA patients with no apparent trauma or injuries isolated to the head/face have a small chance of survival to discharge or organ donation and resuscitation should be attempted until further study can elucidate more prehospital predictors of death.