When trauma patients arrest in ED, many survive

  • Am J Emerg Med
  • 24 Sep 2018

  • curated by Jenny Blair, MD
  • Clinical Essentials
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Takeaway

  • Up to one-third of trauma patients experiencing cardiac arrest shortly after emergency department (ED) arrival survive to discharge. 
  • Authors: these patients “warrant an aggressive approach.”

Why this matters

  • Field CPR due to trauma portends a dismal prognosis.
  • Few data address prognosis of trauma patients whose cardiac arrest occurs shortly after hospital arrival.

Key results

  • Survival with blunt injuries: 
    • CPR commencing 1-60 minutes after arrival, across Injury Severity Scores (ISS): 8.5%-10.2% (P>.05);
    • CPR commencing 61-120 minutes after arrival, ISS 25: 36.1% vs 8.7% (P<.00003>
  • Survival with penetrating injuries:
    • CPR at 1-60 minutes, across ISS: 4.3%-6.8% (P>.05);
    • CPR at 61-120 minutes, ISS 25: 36.4% vs 9.1%.

Study design

  • Retrospective study of American College of Surgeons' National Trauma Data Bank Research Data Set.
  • Researchers assessed 9365 trauma patients who had field vital signs but required CPR commencing between 1 and 120 minutes after hospital arrival.
  • Outcome: survival to discharge.
  • Funding: None.

Limitations

  • Patient ages not specified.
  • Few survivors in some subsets, and 95% confidence intervals not provided, so precision of estimates is unclear.
  • Details on arrest etiology not available.

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