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Impact of cardiopulmonary resuscitation time on the effectiveness of emergency department thoracotomy after blunt trauma

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Abstract

Purpose

Debate remains about the threshold cardiopulmonary resuscitation (CPR) duration associated with futile emergency department thoracotomy (EDT). To validate the CPR duration associated with favorable outcomes, we investigated the relationship between CPR duration and return of spontaneous circulation (ROSC) after EDT in blunt trauma.

Methods

A retrospective observational study was conducted at three tertiary centers over the last 7 years. We included bluntly injured adults who were pulseless and required EDT at presentation, but excluded those with devastating head injuries. After multivariate logistic regression identified the CRP duration as an independent predictor of ROSC, receiver operating characteristic curves were used to determine the threshold CPR duration. Patient data were divided into short- and long-duration CPR groups based on this threshold, and we developed a propensity score to estimate assignment to the short-duration CPR group. The ROSC rates were compared between groups after matching.

Results

Forty patients were eligible for this study and ROSC was obtained in 12. The CPR duration was independently associated with the achievement of ROSC [odds ratio 1.18; 95% confidence interval (CI) 1.01–1.37, P = 0.04], and the threshold CPR duration was 17 min. Among the 14 patients with a short CPR duration, 13 matched with the patients with a long CPR duration, and a short CPR duration was significantly associated with higher rates of ROSC (odds ratio 8.80; 95% CI 1.35–57.43, P = 0.02).

Conclusions

A CPR duration < 17 min is independently associated with higher ROSC rates in patients suffering blunt trauma.

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Author information

Correspondence to Ryo Yamamoto.

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Conflict of interest

Ryo Yamamoto, Masaru Suzuki, Rakuhei Nakama, Kenichi Kase, Kazuhiko Sekine, Tomohiro Kurihara, and Junichi Sasaki declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Informed consent

For this type of retrospective study, formal consent is not required.

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Yamamoto, R., Suzuki, M., Nakama, R. et al. Impact of cardiopulmonary resuscitation time on the effectiveness of emergency department thoracotomy after blunt trauma. Eur J Trauma Emerg Surg 45, 697–704 (2019) doi:10.1007/s00068-018-0967-y

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Keywords

  • Emergency department thoracotomy
  • Cardiopulmonary resuscitation
  • Blunt trauma
  • Traumatic cardiopulmonary arrest