Open-chest cardiopulmonary resuscitation after cardiac arrest in cases of blunt chest or abdominal trauma: a consecutive series of 38 cases.
BACKGROUND
According to the literature, the overall outcome in a patient population with chest or abdominal injury with initial cardiac arrest has to be rated as poor. In cases of penetrating injuries, open-chest cardiopulmonary resuscitation (CPR) has been recommended as a treatment option to improve the survival rate. The aim of this study was to prove equal outcome for patients with blunt chest or abdominal trauma.


METHODS
During a 5-year period, a consecutive patient series admitted to an urban Level I trauma center was examined. Only patients with blunt trauma and witnessed cardiac arrest, who had a documented, uninterrupted closed-chest CPR (CCCPR) of less than 20 minutes were included in this study (n=38). Exclusion criteria were age over 70 years, penetrating injuries, CCCPR of more than 20 minutes, as well as nonprofessional bystander resuscitation.


RESULTS
Four of 38 patients survived. In comparison with the group of nonsurvivors, both groups showed a similar age and gender ratio (mean age, 28, 32, respectively). The mean Injury Severity Scale was 54 (range, 42-66) in the survivor group and 66 (range, 29-75) in the nonsurvivor group, respectively. The time of CCCPR was on average 13 minutes (range, 11-15 minutes) for the survivors and 16 minutes (range, 1-20 minutes) for the nonsurvivors.


CONCLUSIONS
Patients with blunt trunk trauma and cardiac arrest after hemorrhagic shock may benefit from open-chest CPR with the same probability as shown for patients with penetrating injuries. This is especially true if the procedure is started as soon as possible, but at the latest within 20 minutes after initial CCCPR.
Fialka
Christian
C
Department of Traumatology, University of Vienna Medical School, Vienna, Austria. c.fialka@netway.at
Sebök
Christian
C
Kemetzhofer
Peter
P
Kwasny
Oskar
O
Sterz
Fritz
F
Vécsei
Vilmos
V
D000007:Abdominal Injuries / Q000150:complications* / Q000175:diagnosis; D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002648:Child; D004638:Emergency Treatment / Q000379:methods; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000601:surgery*; D006336:Heart Massage; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D008875:Middle Aged; D009104:Multiple Trauma / Q000150:complications / Q000175:diagnosis; D011379:Prognosis; D012189:Retrospective Studies; D018570:Risk Assessment; D012737:Sex Factors; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000150:complications* / Q000175:diagnosis; D013908:Thoracotomy; D014193:Trauma Centers; D016896:Treatment Outcome; D014505:Urban Population; D014949:Wounds, Nonpenetrating / Q000150:complications* / Q000175:diagnosis