Does the prognosis of cardiac arrest differ in trauma patients?
OBJECTIVE
It is proposed to not resuscitate trauma patients who have a cardiac arrest outside the hospital because they are assumed to have a dismal prognosis. Our aim was to compare the outcome of patients with traumatic or nontraumatic ("medical") out-of-hospital cardiac arrest.


METHODS
Cohort analysis of patients with out-of-hospital cardiac arrest included in the European Epinephrine Study Group's trial comparing high vs. standard doses of epinephrine.


METHODS
Nine French university hospitals.


METHODS
A total of 2,910 patients.


METHODS
Patients were successively and randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at 3-min intervals.


RESULTS
Return of spontaneous circulation, survival to hospital admission and discharge, and secondary outcome measures of 1-yr survival and neurologic outcome were recorded. In the trauma group, patients were younger (42 +/- 17 vs. 62 +/- 17 yrs, p < .001), presented with fewer witnessed out-of-hospital cardiac arrests (62.3% vs. 79.7%), and had fewer instances of ventricular fibrillation as the first documented pulseless rhythm (3.4% [95% confidence interval, 1.2-5.5%] vs. 17.3% [15.8-18.7%]). A return of spontaneous circulation was observed in 91 of 268 trauma patients (34.0% [28.3-39.6%]) compared with 797 of 2,642 medical patients (30.2% [28.4-31.9%]), and more trauma patients survived to be admitted to the hospital (29.9% [24.4-35.3%] vs. 23.5% [22.0-25.2%]). However, there was no significant difference between trauma and medical groups at hospital discharge (2.2% [0.5-4.0%] vs. 2.8% [2.1-3.4%]) and 1-yr survival (1.9% [0.3-3.5%] vs. 2.5% [1.9-3.1%]). Among patients who were discharged, a good neurologic status was observed in two trauma patients (33.3% [4.3-77.7%]) and 37 medical patients (50% [38.1-61.9%]).


CONCLUSIONS
The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients. This result suggests that, under the supervision of senior physicians, active resuscitation after out-of-hospital cardiac arrest is as important in trauma as in medical patients.
David
Jean-Stephane
JS
Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France. js-david@univ-lyon1.fr
Gueugniaud
Pierre-Yves
PY
Riou
Bruno
B
Pham
Emmanuel
E
Dubien
Pierre-Yves
PY
Goldstein
Patrick
P
Freysz
Marc
M
Petit
Paul
P
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004837:Epinephrine / Q000008:administration & dosage; D005260:Female; D006323:Heart Arrest / Q000188:drug therapy / Q000209:etiology* / Q000401:mortality*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D014662:Vasoconstrictor Agents / Q000008:administration & dosage; D014947:Wounds and Injuries / Q000150:complications*
D014662:Vasoconstrictor Agents; D004837:Epinephrine