A. Wang2, S. Tohmasi1, R. Fonseca1, L. Kranker1, B. Svancarek1, M. Rosengart1, G. Niziolek1 1Washington University, Acute Care Surgery, St. Louis, MO, USA 2University Of North Carolina At Chapel Hill, School Of Medicine, Chapel Hill, NC, USA
Introduction: Prehospital providers prioritize early cardiopulmonary resuscitation (CPR) in cardiac arrest patients, however, patients with a penetrating etiology may not experience the same survival benefit. We hypothesized that there is no difference in patient survival with the addition of CPR in those patients who have lost pulses in a prehospital setting with penetrating injuries.
Methods: This single-center retrospective observational study was conducted using the institutional trauma registry from an urban level one trauma center. Manual chart review was performed for patients with penetrating injuries who lost pulses en route to the hospital between 2018-2023. Patients were stratified by prehospital CPR status. Primary outcome was trauma bay survival with survival at 6 hours, 24 hours, and hospital discharge as secondary measures.
Results: A total of 211 patients experienced loss of pulses prior to hospital arrival and had penetrating injuries. Of these, 85.8% (n = 181) received prehospital CPR. Those who did not receive prehospital CPR had significantly higher rates of trauma bay survival compared to those who received CPR (46.7% vs 18.8%, p<0.001). Subgroup analysis of those transported by emergency medical services identified similar trends with the no prehospital CPR group having significantly higher rates of trauma bay survival (52.2% vs 16.3, p<0.001), 6 hour survival (26.1% vs 8.7%, p=0.012), and survival to hospital discharge (13.0% vs 3.5%, p=0.040). Patients without prehospital CPR had significantly higher rates of survival in a Kaplan Meir curve (p = .006).
Conclusion: Prehospital CPR in patients with cardiac arrest secondary to penetrating injuries does not improve survival and may be detrimental. Notably, this trend persisted even in the EMS transport only group. Follow-up prospective studies are needed for confirm findings.