Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field.
BACKGROUND
Survival for trauma patients who receive prehospital cardiopulmonary resuscitation (CPR) has been reported as poor. We assessed the survival for prehospital CPR in our trauma system and attempted to find prehospital predictors of mortality.


METHODS
We conducted a retrospective review of our Level I trauma center's database that identified 588 patients over a 6-year period (January 1, 1997, to December 31, 2002) who received prehospital CPR. Mechanisms of injury, prehospital vital signs, and survival to discharge were analyzed.


RESULTS
Twenty-two of 588 patients (3.7%) survived to hospital discharge. Overall, 60.7% did not survive to achieve hospital admission, and an additional 32.6% died on the first hospital day. Patients with penetrating injuries had a significantly lower survival rate than those with either blunt or other (eg, drowning, hanging) injuries (0.9% versus 6.2%, and 13.2%, respectively, p < 0.001) and significantly lower Revised Trauma Scores (RTS; mean +/- SD: 0.32 +/- 0.96 versus 0.76 +/- 1.84 and 1.18 +/- 2.51, respectively, p < 0.05.) The likelihood of survival with RTS = 0 was less than 1% overall, and 0% for penetrating trauma.


CONCLUSIONS
These findings add support to recent guidelines regarding the termination or withholding of resuscitation for trauma patients in the prehospital setting. Victims of penetrating trauma with a prehospital RTS = 0 (combination of no respiratory rate, no systolic blood pressure, and a Glasgow Coma Score of 3) should be declared "dead at the scene."
Stockinger
Zsolt T
ZT
Department of Surgery SL-22, Tulane University Health Sciences Center, 1430 Tulane Avenue, New Orleans, LA 70112-2699, USA.
McSwain
Norman E
NE
D000293:Adolescent; D000328:Adult; D016887:Cardiopulmonary Resuscitation; D004632:Emergency Medical Services; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D016019:Survival Analysis; D014947:Wounds and Injuries / Q000401:mortality*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy