Outcomes from Prehospital Cardiac Arrest in Blunt Trauma Patients
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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.
KeywordsVentricular Fibrillation Emergency Medical Service Transcatheter Arterial Embolization Pulseless Electrical Activity Emergency Medical Service System
- 6.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 7:141–146Google Scholar
- 8.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 53:175–178PubMedGoogle Scholar
- 9.Moriwaki Y, Sugiyama M, Hayashi H et al (2001) Emergency medical service system in Yokohama, Japan. Ann Degli Ospedali San Camillo Forlanini 3:344–356Google Scholar
- 30.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 78:307–313CrossRefPubMedGoogle Scholar