Does the prognosis of cardiac arrest differ in trauma patients
TL;DR: The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients, suggesting that, under the supervision of senior physicians, active resuscitation after out- of- hospital cardiac arrest is as important in trauma as in medical patients.
Abstract: OBJECTIVE: It is proposed to not resuscitate trauma patients who have a cardiac arrest outside the hospital because they are assumed to have a dismal prognosis. Our aim was to compare the outcome of patients with traumatic or nontraumatic ("medical") out-of-hospital cardiac arrest.
DESIGN: Cohort analysis of patients with out-of-hospital cardiac arrest included in the European Epinephrine Study Group's trial comparing high vs. standard doses of epinephrine.
SETTING: Nine French university hospitals.
PATIENTS: A total of 2,910 patients.
INTERVENTIONS: Patients were successively and randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at 3-min intervals.
MEASUREMENTS AND MAIN RESULTS: Return of spontaneous circulation, survival to hospital admission and discharge, and secondary outcome measures of 1-yr survival and neurologic outcome were recorded. In the trauma group, patients were younger (42 +/- 17 vs. 62 +/- 17 yrs, p <.001), presented with fewer witnessed out-of-hospital cardiac arrests (62.3% vs. 79.7%), and had fewer instances of ventricular fibrillation as the first documented pulseless rhythm (3.4% [95% confidence interval, 1.2-5.5%] vs. 17.3% [15.8-18.7%]). A return of spontaneous circulation was observed in 91 of 268 trauma patients (34.0% [28.3-39.6%]) compared with 797 of 2,642 medical patients (30.2% [28.4-31.9%]), and more trauma patients survived to be admitted to the hospital (29.9% [24.4-35.3%] vs. 23.5% [22.0-25.2%]). However, there was no significant difference between trauma and medical groups at hospital discharge (2.2% [0.5-4.0%] vs. 2.8% [2.1-3.4%]) and 1-yr survival (1.9% [0.3-3.5%] vs. 2.5% [1.9-3.1%]). Among patients who were discharged, a good neurologic status was observed in two trauma patients (33.3% [4.3-77.7%]) and 37 medical patients (50% [38.1-61.9%]).
CONCLUSIONS: The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients. This result suggests that, under the supervision of senior physicians, active resuscitation after out-of-hospital cardiac arrest is as important in trauma as in medical patients.
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North Bristol NHS Trust1, University of Warwick2, Queen Margaret Hospital3, The Catholic University of America4, University of Southampton5, James Cook University Hospital6, Nicosia General Hospital7, Frenchay Hospital8, University of Innsbruck9, Children's of Alabama10, Imperial College Healthcare11, Royal United Hospital12
TL;DR: The guidelines for resuscitation of cardiac arrest in special circumstances in Europe focused on cardiac surgery, trauma, pregnancy, electrocution, and electlyte abnormalities and oisoning.
532 citations
TL;DR: This IABO procedure can be life saving in the management of patients with CUHS from PF, permitting transport to angiography, however, the decision for such treatment must be as quickly as possible after trauma to reduce the time of occlusion.
Abstract: Objective The purpose of this study was to describe a blinded intra-aortic balloon occlusion (IABO) procedure in pelvic fractures (PF) for patients with critically uncontrollable hemorrhagic shock (CUHS). Methods Of 2,064 patients treated for PF, 13 underwent IABO during initial resuscitation to control massive pelvic bleeding leading to CUHS. Our IABO procedure consists of internal aortic occlusion without fluoroscopy, using a latex balloon inflated in the infrarenal aorta. Retrospectively collected data included demographics, fracture classification, additional injuries, blood transfusions, surgical interventions, angiographic procedure, physiologic parameters, and survival. Results All balloons were successfully placed, and a significant increase in systolic blood pressure (70 mm Hg, p = 0.001) was observed immediately after IABO. Twelve of 13 patients became transferrable. Angiography performed after IABO was positive for arterial injury in 92% of patients, and 9 patients benefitted from arterial embolization. Survival rate was 46% (6 of 13) and was inversely related to the length of inflation (p = 0.026) and the mean Injury Severity Score (p = 0.011). Conclusion This IABO procedure can be life saving in the management of patients with CUHS from PF, permitting transport to angiography. However, the decision for such treatment must be as quickly as possible after trauma to reduce the time of occlusion.
234 citations
TL;DR: The S3 guideline on polytrauma does not claim to be complete, but important subjects such as the medical care of children have not yet been integrated into the guideline, but it is planned to include them in the next revision.
Abstract: Die Versorgung schwerstverletzter Patienten im Schockraum bedeutet fur das multidisziplinare Behandlungsteam einen strukturierten Evaluationsprozess in einen zielgerichteten Behandlungsprozess zu uberfuhren. Neben dem Faktor Zeit und dem Erkennen vital bedrohlicher Verletzungen, die haufig unter dem Begriff „deadly six“ zusammengefasst werden, sollten aber auch sog. „Bagatellverletzungen“ nicht ubersehen werden, da sie die Lebensqualitat nach Trauma mitunter entscheidend beeinflussen konnen. Die S3-Leitlinie Polytrauma erhebt nicht den Anspruch auf Vollstandigkeit. Wichtige Inhalte, wie z. B. die Versorgung von Kindern sind bisher noch nicht in die Leitlinie eingeflossen, werden aber fur die Uberarbeitung fest eingeplant.
161 citations
TL;DR: The German Trauma Society (DGU) (lead) Office in Langenbeck-Virchow House Luisenstr.
Abstract: German Trauma Society (DGU) (lead) Office in Langenbeck-Virchow House Luisenstr. 58/59 10117 Berlin German Society of General and Visceral Surgery German Society of Anesthesiology and Intensive Care Medicine German Society of Endovascular and Vascular Surgery German Society of Hand Surgery German Society of Oto-Rhino-Laryngology, Head and Neck Surgery German Interdisciplinary Association for Emergency and Acute Care Medicine German Society of Oral and Maxillofacial Surgery German Society of Neurosurgery German Society of Thoracic surgery German Society of Urology German Radiology Society German Society of Plastic, Reconstructive and Aesthetic Surgeons German Society of Gynecology and Obstetrics German Society of Pediatric Surgery German Society for Transfusion Medicine and Immunohematology German Society for Burn Medicine German Interdisciplinary Association for Intensive and Emergency Medicine German Professional Association of Emergency Medical Services Society of Pediatric Radiology
110 citations
References
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Journal Article•
641 citations
TL;DR: A prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest, which showed a return of spontaneous circulation in the high-dose group.
Abstract: Background Clinical trials have not shown a benefit of high doses of epinephrine in the management of cardiac arrest. We conducted a prospective, multicenter, randomized study comparing repeated high doses of epinephrine with repeated standard doses in cases of out-of-hospital cardiac arrest. Methods Adult patients who had cardiac arrest outside the hospital were enrolled if the cardiac rhythm continued to be ventricular fibrillation despite the administration of external electrical shocks, or if they had asystole or pulseless electrical activity at the time epinephrine was administered. We randomly assigned 3327 patients to receive up to 15 high doses (5 mg each) or standard doses (1 mg each) of epinephrine according to the current protocol for advanced cardiac life support. Results In the high-dose group, 40.4 percent of 1677 patients had a return of spontaneous circulation, as compared with 36.4 percent of 1650 patients in the standard-dose group (P=0.02); 26.5 percent of the patients in the high-dose ...
261 citations
228 citations
TL;DR: Trauma patients who require CPR at the scene or in transport die, and society should decide if the "cost of futility" is excessive, and the wisdom of transporting trauma victims suffering cardiopulmonary arrest at thescene or during transport must be questioned.
Abstract: Of 12,462 trauma patients cared for by prehospital services from October 1, 1989 to March 31, 1991, 138 patients underwent CPR at the scene or during transport because of the absence of blood pressure, pulse, and respiration. Ninety-six (70%) suffered blunt trauma, 42 (30%) suffered penetrating trauma. Sixty (43%) were transported by air utilizing county-wide transport protocols. None of the patients survived. Aggregate care cost $871, 186.00. In 11 cases (8%), tissue for transplantation was procured (only corneas). Conclusion: Trauma patients who require CPR at the scene or in transport die. Infrequent organ procurement does not seem to justify the cost (primarily borne by hospitals), consumption of resources, and exposure of health care providers to occupational health hazards
222 citations
"Does the prognosis of cardiac arres..." refers background in this paper
...I t is usually assumed that trauma victims with cardiac arrest in the prehospital setting have a dismal prognosis, leading physicians to consider cardiopulmonary resuscitation as futile (1)....
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TL;DR: The survival rates described are poor but comparable with (or better than) published survival rates for out-of-hospital cardiac arrest of any cause; patients who arrest after hypoxic insults and those who undergo out- of-hospital thoracotomy after penetrating trauma have a higher chance of survival.
216 citations
"Does the prognosis of cardiac arres..." refers background in this paper
...It has also been shown that for patients in cardiac arrest after penetrating trauma, prehospital thoracotomy may be a possibility (10, 26)....
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...(10) between survival rates and mechanism of trauma in trauma patients with OHCA....
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...Hence, in many European countries, patients with traumatic OHCA are usually actively treated and receive the same level of care as patients with medical OHCA, with the addition of specific care to trauma (10, 11)....
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