A Little Hope for Traumatic Arrest

January 6, 2017

Short Attention Span Summary

Traumatic arrest = dead, right?
I was always taught that CPR in traumatic arrest is a futile effort.  And while the prognosis was poor, this study found that 9/88 (10%) patients with blunt traumatic arrest survived with an excellent neurological outcome at 6 month follow up.  Hypoxia was the most likely cause of arrest in those who survived.  This means that not all CPR in traumatic arrest is in vain, especially if the reason they arrested is hypoxia.  But the prognosis is still grim.

Spoon Feed
If hypoxia is the cause of traumatic arrest, the prognosis is better than expected.  emDocs has an excellent summary on traumatic cardiac arrest.

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Abstract

Emerg Med J. 2016 Oct 26. pii: emermed-2014-204596. doi: 10.1136/emermed-2014-204596. [Epub ahead of print]

Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest.

Duchateau FX1, Hamada S2, Raux M3, Gay M1, Mantz J4, Paugam Burtz C4,5, Gauss T4; Traumabase Group.

Collaborators: (5)

Duranteau J, Riou B, Vigué B, Langeron O, Harrois A.

Author information:

1Emergency Medical Service Department, Beaujon University Hospital, Clichy, France.

2Department of Anaesthesiology and Intensive Care, Hôpitaux Universitaires Paris Sud, Université Paris Sud, Hôpital de Bicêtre, Le Kremlin-Bicêtre, France.

3Department of Anaesthesiology and Intensive Care, Pitié Salpétrière University Hospital, Paris, France.

4Department of Anaesthesiology and Critical Care, Beaujon University Hospital, Clichy, France.

5Université Denis Diderot-Paris VII, Paris, France.

Abstract

BACKGROUND:

Although prehospital cardiac arrest (CA) remains associated with poor long-term outcome, recent studies show an improvement in the survival rate after prehospital trauma associated CA (TCA). However, data on the long-term neurological outcome of TCA, particularly from physician-staffed Emergency Medical Service (EMS), are scarce, and results reported have been inconsistent. The objective of this pilot study was to evaluate the long-term outcome of patients admitted to several trauma centres after a TCA.

METHODS:

This study is a retrospective database review of all patients from a multicentre prospective registry that experienced a TCA and had undergone successful cardiopulmonary resuscitation (CPR) prior their admission at the trauma centre. The primary end point was neurological outcome at 6 months among patients who survived to hospital discharge.

RESULTS:

88 victims of TCA underwent successful CPR and were admitted to the hospital, 90% of whom were victims of blunt trauma. Of these 88 patients, 10 patients (11%; CI 95% 6% to 19%) survived to discharge: on discharge, 9 patients displayed a GCS of 15 and Cerebral Performance Categories (CPC) 1-2 and one patient had a GCS 7 and CPC of 3. Hypoxia was the most frequent cause of CA among survivors. 6-month follow-up was achieved for 9 patients of the 10 surviving patients. The 9 patients with a good outcome on hospital discharge had a CPC of 1 or 2 6 months post discharge. All returned to their premorbid family and social settings.

CONCLUSIONS:

Among patients admitted to hospital after successful CPR from TCA, hypoxia as the likely aetiology of arrest carried a more favourable prognosis. Most of the patients successfully resuscitated from TCA and surviving to hospital discharge had a good neurological outcome, suggesting that prehospital resuscitation may not be futile.

Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/.

PMID: 27797869 [PubMed – as supplied by publisher]