Skip to main page content
Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
, 15 (6), R276

Cardiopulmonary Resuscitation Traumatic Cardiac Arrest--There Are Survivors. An Analysis of Two National Emergency Registries

Affiliations

Cardiopulmonary Resuscitation Traumatic Cardiac Arrest--There Are Survivors. An Analysis of Two National Emergency Registries

Jan-Thorsten Gräsner et al. Crit Care.

Abstract

Introduction: Cardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany.

Methods: This study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted.

Results: Within the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome.

Conclusions: Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged.

Figures

Figure 1
Figure 1
Results for 368 patients with traumatic cardiac arrest and pre-hospital CPR based on the German Resuscitation Registry (GRR). BP, blood pressure; CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation.
Figure 2
Figure 2
Overview of hospital mortality rates, based on cardiopulmonary resuscitation (pre-hospital) and initial circulation (blood pressure). BP, blood pressure; CPR, cardiopulmonary resuscitation; ED, emergency department; n.d., not documented; ROSC, return of spontaneous circulation.
Figure 3
Figure 3
Summary of the results from the German Resuscitation Registry (GRR) and the Trauma Registry of the German Society for Trauma Surgery (TR-DGU) for patients with traumatic cardiac arrest in whom CPR was started (defined as 100%). CPR, cardiopulmonary resuscitation; ROSC, return of spontaneous circulation.

Comment in

Similar articles

See all similar articles

Cited by 18 PubMed Central articles

See all "Cited by" articles

References

    1. Gräsner JT, Meybohm P, Fischer M, Bein B, Wnent J, Franz R, Zander J, Lemke H, Bahr J, Jantzen T, Messelken M, Dorges V, Böttiger BW, Scholz J. A national resuscitation registry of out-of-hospital cardiac arrest in Germany-a pilot study. Resuscitation. 2009;80:199–203. doi: 10.1016/j.resuscitation.2008.10.008. - DOI - PubMed
    1. Bouillon B, Walther T, Kramer M, Neugebauer E. Trauma and circulatory arrest. 224 preclinical resuscitations in Cologne in 1987-1990. Anaesthesist. 1994;43:786–790. doi: 10.1007/s001010050124. - DOI - PubMed
    1. Huber-Wagner S, Lefering R, Qvick M, Kay MV, Paffrath T, Mutschler W, Kanz KG. Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation. 2007;75:276–285. doi: 10.1016/j.resuscitation.2007.04.018. - DOI - PubMed
    1. Campell J. Basic trauma life support for advanced providers. 5. Persons Education; 2007.
    1. Hopson LR, Hirsh E, Delgado J, Domeier RM, McSwain NE Jr, Krohmer J. 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. Prehosp Emerg Care. 2003;7:141–146. doi: 10.1080/10903120390937274. - DOI - PubMed

MeSH terms

Feedback