There are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system.
The 477 BT-CPA registry data were augmented by a review of the detailed medical records in our emergency department (ED) and action reports in the prehospital EMS records.
Of those, 76% were witnessed and 20% were CPA after leaving the scene. In all, 18% of the patients went to the intensive care unit (ICU), the transcatheter arterial embolization (TAE) room, or the operating room (OR). Only 3% survived to be discharged. Among the 363 witnessed patients—11 of whom had ventricular fibrillation (VF) as the initial rhythm, 134 exhibiting pulseless electrical activity (PEA), and 221 with asystole—13, 1, and 3%, respectively, survived to discharge. The most common initial rhythm just after collapse was not VF but PEA, and asystole increased over the 7 min after collapse. There were no differences in the interval between arrival at the hospital and the return of spontaneous circulation between the patients that survived to discharge and deceased patients in the ED, OR, TAE room, or ICU. The longest interval was 17 min.
In BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.
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Willis CD, Cameron PA, Bernard SA et al (2006) Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury 37:448–454
Lockey D, Crewdson K, Davies G (2006) Traumatic cardiac arrest: who are the survivors? Ann Emerg Med 48:240–244
Pickens JJ, Copass MK, Bulger EM (2005) Trauma patients receiving CPR: predictors of survival. J Trauma 58:951–958
Pepe PE, Swor RA, Ornato JP et al (2001) Resuscitation in the out-of-hospital setting: medical futility criteria for on-scene pronouncement of death. Prehosp Emerg Care 5:79–87
Grove CA, Lemmon G, Anderson G et al (2002) Emergency thoracotomy: appropriate use in the resuscitation of trauma patients. Am Surg 68:313–317
Hopson LR, Hirsh E, Delgado J, et al (2003) Guidelines for withholding or termination of resuscitation in prehospital traumatic cardiopulmonary arrest: a joint position paper from the National Association of EMS Physicians Standards and Clinical Practice Committee and the American College of Surgeons Committee on Trauma. J Am Coll Surg 196:106–112; Prehosp Emerg Care 7:141–146
Powell DW, Moore EE, Cothren CC et al (2004) Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation? J Am Coll Surg 199:211–215
Moriwaki Y, Sugiyama M, Toyoda H et al (2006) Monitoring and evaluation of intraperitoneal bleeding (IPB) by small portable ultrasonography during transcatheter arterial embolization (TAE) in abdominal-pelvic trauma patients with shock: as a monitor for early detection of increase of IPB. Hepatogastroenterology 53:175–178
Moriwaki Y, Sugiyama M, Hayashi H et al (2001) Emergency medical service system in Yokohama, Japan. Ann Degli Ospedali San Camillo Forlanini 3:344–356
Cera SM, Mostafa G, Sing RF et al (2003) Physiologic predictors of survival in post-traumatic arrest. Am Surg 69:140–144
Rosemurgy AS, Norris PA, Olson SM et al (1993) Prehospital traumatic cardiac arrest: the cost of futility. J Trauma 35:468–474
Mazzorana V, Smith RS, Morabito DJ et al (1994) Limited utility of emergency department thoracotomy. Am Surg 60:516–521
Luk SS, Jacobs L, Ciraulo DL et al (1999) Outcome assessment of physiologic and clinical predictors of survival inpatients after traumatic injury with trauma score less than 5. J Trauma 46:122–128
Fulton RL, Voigt WJ, Hilakos AS (1995) Confusion surrounding the treatment of traumatic cardiac arrest. J AM Coll Surg 181:209–214
Boczar ME, Howard MA, Rivers EP et al (1995) A technique revisited: hemodynamic comparison of closed- and open-chest cardiac massage during human cardiopulmonary resuscitation. Crit Care Med 23:498–503
Takino M, Okada Y (1993) The optimum timing of resuscitative thoracotomy for non-traumatic out-of-hospital cardiac arrest. Resuscitation 26:69–74
Weil MH, Rackow EC, Trevino R et al (1986) Difference in acid-base state between venous and arterial blood during cardiopulmonary resuscitation. N Engl J Med 315:153–156
Angelos MG, DeBehnke DJ, Leasure JE (1992) Arterial pH and carbon dioxide tension as indicators of tissue perfusion during cardiac arrest in a canine model. Crit Care Med 20:1302–1308
DeBehnke DJ, Angelos MG, Leasure JE (1991) Comparison of standard external CPR, open-chest CPR, and cardiopulmonary bypass in a canine myocardial infarct model. Ann Emerg Med 20:754–760
Bircher N, Safar P (1985) Cerebral preservation during cardiopulmonary resuscitation. Crit Care Med 13:185–190
Kern KB, Sanders AB, Badylak SF et al (1987) Long-term survival with open-chest cardiac massage after ineffective closed-chest compression in a canine preparation. Circulation 75:498–503
Raessler KL, Kern KB, Sanders AB et al (1988) Aortic and right atrial systolic pressures during cardiopulmonary resuscitation: a potential indicator of the mechanism of blood flow. Am Heart J 115:1021–1029
Fialka C, Sebok C, Kemetzhofer P et al (2004) Open-chest cardiopulmonary resuscitation after cardiac arrest in cases of blunt chest or abdominal trauma: a consecutive series of 38 cases. J Trauma 57:809–814
Moriwaki Y, Sugiyama M, Toyoda H et al (2010) Cardiopulmonary arrest on arrival due to penetrating trauma. Ann R Coll Surg Engl 92:142–146
Hallstrom A, Rea TD, Mosesso VN Jr et al (2007) The relationship between shocks and survival in out-of-hospital cardiac arrest patients initially found in PEA or asystole. Resuscitation 74:418–426
Herlitz J, Bahr J, Fischer M et al (1999) Resuscitation in Europe: a tale of five European regions. Resuscitation 41:121–131
Bunch TJ, Hammill SC, White RD (2005) Outcomes after ventricular fibrillation out-of-hospital cardiac arrest: expanding the chain of survival. Mayo Clin Proc 80:774–782
Atwood C, Eisenberg MS, Herlitz J et al (2005) Incidence of EMS-treated out-of-hospital cardiac arrest in Europe. Resuscitation 67:75–80
Rea TD, Eisenberg MS, Sinibaldi G et al (2004) Incidence of EMS-treated out-of-hospital cardiac arrest in the United States. Resuscitation 63:17–24
Nishiuchi T, Hayashino Y, Fukuhara S et al (2008) Survival rate and factors associated with 1-month survival of witnessed out-of-hospital cardiac arrest of cardiac origin with ventricular fibrillation and pulseless ventricular tachycardia: the Utstein Osaka project. Resuscitation 78:307–313
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Moriwaki, Y., Sugiyama, M., Yamamoto, T. et al. Outcomes from Prehospital Cardiac Arrest in Blunt Trauma Patients. World J Surg 35, 34–42 (2011) doi:10.1007/s00268-010-0798-4
- Ventricular Fibrillation
- Emergency Medical Service
- Transcatheter Arterial Embolization
- Pulseless Electrical Activity
- Emergency Medical Service System