Outcome of aggressive treatment for blunt and penetrating traumatic cardiac arrest

Introduction

The outcome of patients with cardiac arrest due to blunt trauma (BT-CPA) and penetrating trauma (PT-CPA) is very poor. The aim of this study is to clarify the outcome of patients with CPA on arrival due to BT-CPA and PT-CPA treated with our strategy including emergency department thoracotomy (EDT).

Methods

This study is a population-based case series observational study. We have taken three approaches to these patients: our private aggressive treatment strategy (resuscitation for 30 minutes, aggressive infusion using sheath introducer into the subclavian vein, and EDT); in-hospital system supporting this aggressive resuscitation (logistic issue such as the close location between ED and the room for catheter intervention and CT, and direct entrance to the OR by exclusive lift, and common instruments interchangeable between ED and OR including the bed); and prehospital EMS in our city (CPA patients are transferred in about 7 minutes to the nearest of selected 11 hospitals which can receive and treat CPA patients).

Results

For the past 10 years, of 478 BT-CPA and 30 PT-CPA patients, 76% and 70% were witnessed, and 21% and 37% were CPA after scene. A total of 85% and 77% underwent EDT. Although 34% and 60% achieved ROSC, only 18% and 40% went to the ICU, TAE room, and OR (admitted), and only 2.7% and 17% were discharged (survivors). Restricted in eight witnessed patients showing VF as the initial cardiac rhythm in BT-CPA, 38% were admitted and 13% survived. No PT-CPA patients showed VF. Restricted in 134 witnessed patients showing PEA in BT-CPA and 10 in PT-CPA, 28% and 70% were admitted and 1% and 30% survived. Two hundred and twenty witnessed patients showing no life sign (asystole) in BT-CPA and 12 in PT-CPA, 8% and 25% were admitted, and 3% and 17% survived. The initial rhythm of survivors was asystole in 70% in BT-CPA and 40% in PT-CPA. Although the time interval from arrival at the hospital to ROSC of survivors tended to be shorter than for nonsurvivors in BT-CPA, there was no difference in this interval in PT-CPA. The longest interval was 43 and 30 minutes in BT-CPA and PT-CPA.

Conclusions

The expected outcome of BT-CPA and PT-CPA patients is hopeless. However, we cannot and should not give up on resuscitating them merely because they are CPA and they do not show any life sign at the scene. We consider the indication of aggressive resuscitation in every individual case by his/her individual condition.