World Journal of Surgery

, Volume 36, Issue 8, pp 1772–1778 | Cite as

Biochemical Profile and Outcomes in Trauma Patients Subjected to Open Cardiopulmonary Resuscitation: A Prospective Observational Pilot Study

  • Beat Schnüriger
  • Peep TalvingEmail author
  • Kenji Inaba
  • Galinos Barmparas
  • Bernardino C. Branco
  • Lydia Lam
  • Demetrios Demetriades



The predictive factors to regain a heartbeat following emergency department resuscitative thoracotomy (EDT) for trauma are poorly understood. The objective of the present study was to prospectively assess the electrolyte profile, coagulation parameters, and acid-base status from intracardiac blood samples in trauma patients subjected to open cardiopulmonary resuscitation (CPR) in the presence of established cardiac arrest.


All patients who underwent EDT following trauma were considered for inclusion. Prior to the injection of any resuscitative medications, a sample of intracardiac blood from the right ventricle was obtained for analysis.


During the study period, a total of 22 patients had intracardiac blood samples obtained and were eligible for analysis. Twelve patients never regained cardiac activity, and 10 patients transiently regained a heartbeat for a mean of 51 ± 69 min, but ultimately died. Some 91 % (20/22) of patients presented with severe acidosis (pH < 7.20). The pCO2 was <45 mmHg in 68 % (15/22) of patients, and the pO2 level was >75 mmHg in 77 % (17/22) of patients. Patients who never regained cardiac activity had a significantly higher lactate level than those with a return of cardiac rhythm (17.1 ± 2.6 vs. 10.6 ± 4.9 mmol/L, p = 0.018). The sodium and potassium levels were higher for those who never regained a rhythm than for those who did regain a pulse (sodium: 155 ± 14 vs. 147 ± 9 mmol/L, p = 0.094; potassium: 6.0 ± 1.1 vs. 4.6 ± 1.0 mmol/L, p = 0.014). Severe hyperkalemia (potassium > 5.5 mmol/L) occurred significantly more often in patients who did not regain a heart beat (p = 0.030). Coagulopathy (INR > 1.2 and/or prothrombin time >15 s and/or platelet count <100,000/μL) was noted in 96 % of patients.


Most patients undergoing open CPR have normal blood gas levels. Severe lactic acidosis, hyperkalemia, and hypernatremia are associated with decreased probability for return of cardiac function. Calcium and magnesium levels were not significantly different between the two groups, making the therapeutic role of these electrolytes very questionable.


Cardiac Rhythm Cardiac Activity Injury Characteristic Severe Lactic Acidosis Severe Hyperkalemia 
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  1. 1.
    Rhee PM, Acosta J, Bridgeman A et al (2000) Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg 190:288–298PubMedCrossRefGoogle Scholar
  2. 2.
    Demetriades D, Rabinowitz B, Sofianos C (1987) Emergency room thoracotomy for stab wounds to the chest and neck. J Trauma 27:483–485PubMedCrossRefGoogle Scholar
  3. 3.
    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 57:809–814PubMedCrossRefGoogle Scholar
  4. 4.
    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 199:211–215PubMedCrossRefGoogle Scholar
  5. 5.
    Schnuriger B, Inaba K, Branco BC et al (2010) Organ donation: an important outcome after resuscitative thoracotomy. J Am Coll Surg 211:450–455PubMedCrossRefGoogle Scholar
  6. 6.
    Makino J, Uchino S, Morimatsu H et al (2005) A quantitative analysis of the acidosis of cardiac arrest: a prospective observational study. Crit Care 9:R357–R362PubMedCrossRefGoogle Scholar
  7. 7.
    Cannon LA, Heiselman DE, Dougherty JM et al (1987) Magnesium levels in cardiac arrest victims: relationship between magnesium levels and successful resuscitation. Ann Emerg Med 16:1195–1199PubMedCrossRefGoogle Scholar
  8. 8.
    Vivien B, Langeron O, Morell E et al (2005) Early hypocalcemia in severe trauma. Crit Care Med 33:1946–1952PubMedCrossRefGoogle Scholar
  9. 9.
    Reis AG, Ferreira de Paiva E et al (2008) Magnesium in cardiopulmonary resuscitation: critical review. Resuscitation 77:21–25PubMedCrossRefGoogle Scholar
  10. 10.
    Stiell IG, Wells GA et al (1995) Association of drug therapy with survival in cardiac arrest: limited role of advanced cardiac life support drugs. Acad Emerg Med 2:264–273PubMedCrossRefGoogle Scholar
  11. 11.
    Allegra J, Lavery R, Cody R et al (2001) Magnesium sulfate in the treatment of refractory ventricular fibrillation in the prehospital setting. Resuscitation 49:245–249PubMedCrossRefGoogle Scholar
  12. 12.
    Fatovich DM, Prentice DA, Dobb GJ (1997) Magnesium in cardiac arrest (the magic trial). Resuscitation 35:237–241PubMedCrossRefGoogle Scholar
  13. 13.
    Hassan TB, Jagger C, Barnett DB (2002) A randomised trial to investigate the efficacy of magnesium sulphate for refractory ventricular fibrillation. Emerg Med J 19:57–62PubMedCrossRefGoogle Scholar
  14. 14.
    Brohi K, Cohen MJ, Ganter MT et al (2007) Acute traumatic coagulopathy: initiated by hypoperfusion: modulated through the protein C pathway? Ann Surg 245:812–818PubMedCrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2012

Authors and Affiliations

  • Beat Schnüriger
    • 1
  • Peep Talving
    • 1
    Email author
  • Kenji Inaba
    • 1
  • Galinos Barmparas
    • 1
  • Bernardino C. Branco
    • 1
  • Lydia Lam
    • 1
  • Demetrios Demetriades
    • 1
  1. 1.Division of Trauma, Emergency Surgery and Surgical Critical Care, Los Angeles County Medical CenterUniversity of Southern California, Keck School of Medicine, LAC + USC Medical CenterLos AngelesUSA

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