Trauma patients receiving CPR: predictors of survival.
OBJECTIVE
To determine whether prehospital clinical assessments are associated with the survival of traumatic cardiopulmonary arrest (TCPA) patients and to test recently issued clinical guidelines for prehospital cessation of resuscitative efforts published by the National Association of Emergency Physicians and the American College of Surgeons Committee on Trauma.


METHODS
A retrospective cohort study was done of all TCPA patients who had transported to a Level I trauma center by a municipal EMS provider between January 1, 1994 and April 1, 2001. Data regarding mechanism of injury, clinical assessments and care provided by EMS and the emergency department (ED), hospital care, survival, and neurologic outcome was collected.


RESULTS
184 patients met exclusion criteria, with 14 (7.6%) surviving to discharge. Pupillary response to light, presence of a prehospital pulse or respiratory effort, a sinus electrocardiogram, and a Glascow Coma Scale greater than three were all significantly associated with survival but were not exclusive. 28.6% of patients admitted to the trauma center from the ED survived. There were frequent discrepancies between prehospital and ED clinical assessments. Several survivors met criteria for non-treatment according to the proposed clinical guidelines.


CONCLUSIONS
+/- Prehospital clinical assessments are not reliable for the triage of TCPA patients. Patients should be transported to the ED for further evaluation and care. The guidelines should not adopted until more thorough studies are conducted.
Pickens
John J
JJ
Department of Surgery, Harborview Medical Center, University of Washington, Seattle 98104-2420, USA.
Copass
Michael K
MK
Bulger
Eileen M
EM
D000293:Adolescent; D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation / Q000401:mortality*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D015897:Comorbidity; D004632:Emergency Medical Services / Q000592:standards / Q000706:statistics & numerical data*; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006323:Heart Arrest / Q000175:diagnosis / Q000401:mortality* / Q000628:therapy*; D006801:Humans; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D010043:Outcome and Process Assessment, Health Care; D017410:Practice Guidelines as Topic; D011787:Quality of Health Care / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D016019:Survival Analysis; D019037:Urban Health Services / Q000592:standards; D014861:Washington / Q000453:epidemiology; D014947:Wounds and Injuries / Q000401:mortality* / Q000628:therapy*; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000628:therapy; D014950:Wounds, Penetrating / Q000401:mortality / Q000628:therapy