Introduction:
Cardiac arrest following traumatic injury is almost universally fatal. While generally regarded as futile, recent literature has advocated for universal use of cardiopulmonary resuscitation (CPR) for arrest following injury. We sought to evaluate the influence of CPR duration on survival after traumatic arrest.
Methods:
All adult trauma patients requiring CPR at presentation to an American College of Surgeons verified level I trauma center from June 1, 2014-August 1,2016 were identified. Patients without identifiable CPR duration or with primarily anoxic brain injury were excluded. Demographic, pre-hospital and emergency department (ED) CPR duration, procedural information, blood product utilization, and mortality data were collected. Multivariate regression followed univariate analysis.
Results:
183 patients were identified with 128 eligible for analysis. The majority were male (78.9%) with an average age of 44.3±18.6 years. Blunt mechanism of injury was more common (59.4%). Resuscitative thoracotomy was performed in 20 patients (15.6%) with one patient surviving. 10.2% overall (13/128) survived to undergo operation with one additional survivor. Mean pre-hospital (9.4 vs. 0.0 minutes, p<0.001), ER (13.0 vs. 2.5 minutes, p<0.001), and total CPR duration (22.4 vs. 2.5 minutes, p<0.001) were significantly different between non-survivors and survivors. Survival to either operation or resuscitative thoracotomy was inversely correlated to CPR duration (OR 0.88; CI 95% 0.83-0.94) on multivariate analysis.
Conclusions:
For patients suffering traumatic cardiac arrest, short duration CPR may be beneficial as a bridge to immediate intervention and hemorrhage control. Prolonged periods of CPR without hemorrhage control are likely futile and unlikely to result in survival.
