Elkbuli A, Flores R, Dowd B, Hai S, Boneva D, McKenney M. Am. J. Emerg. Med. 2018; 36(12): 2276-2278.
Affiliation
Department of Surgery, Kendall Regional Medical Center, Miami, FL, United States of America; Department of Surgery, University of South Florida, Tampa, FL, United States of America.
BACKGROUND: Cardio Pulmonary Resuscitation (CPR) for traumatized patients in the field portends poor survival but the outcome of trauma patients who arrive in-extremis and undergo CPR shortly after arrival has not been well studied. The purpose of our review is to evaluate survival to discharge for trauma patients with CPR from 1 to 120 minutes (min) after arrival.
METHODS: The NTDB Research Data Set (RDS) was reviewed. Patients with vitals in the field who underwent CPR from 1 to 120 min after arrival were divided according to injury type and Injury Severity Score (ISS). Survival to discharge outcomes were determined in patients that underwent CPR from 1-60 min and 61-120 min after arrival.
RESULTS: The RDS contained 968,665 patients and 9,365 (0.96%) had CPR from 1 to 120 min after arrival. For blunt injuries with CPR from 1 to 60 min, survival was similar for all levels of ISS (8.5-10.2%, p > 0.05). Blunt injury patients with CPR 61-120 min and ISS 1-15 had significantly higher survival rate compared to ISS >25 (36.1% vs 8.7%, p < 0.00003). For penetrating injuries and CPR from 1 to 60 min, survival was similar for all levels of ISS (4.3-6.8%, p > 0.05); Blunt and penetrating patients with CPR from 61 to 120 min, and ISS 1-15 had the highest survivals at 36.1 and 36.4%.
CONCLUSION: Trauma patients who undergo CPR shortly after arrival have a survival rate of (4.3%-36.4%). Over one-third of blunt and penetrating injuries and low ISS who had CPR from 61 to 120 min after arrival survived. Trauma patients who arrest shortly after arrival warrant an aggressive approach.