Cardiopulmonary arrest on arrival due to penetrating trauma.
BACKGROUND
The aim of this study was to clarify the outcome of patients with cardiopulmonary arrest on arrival due to penetrating trauma (PT-CPA) and to establish the treatment strategy.


METHODS
The clinical course of 29 patients with PT-CPA over the past 10 years was examined. We have taken three approaches to these patients: (i) an aggressive treatment strategy; (ii) an in-hospital system supporting this aggressive resuscitation; and (iii) the pre-hospital emergency medical service (EMS) system in our city.


RESULTS
Although the return of spontaneous circulation (ROSC) was established in 59% of patients, only 17% survived for 7 days, 14% were discharged, and 7% were neurologically intact. Of 10 patients showing pulseless electrical activity (PEA) on the scene, ROSC was established in 100% and 30% were discharged; however, of 12 patients showing asystole, ROSC was established in 33% and no patient could be discharged. There was no difference in the time interval from the arrival at the emergency department to ROSC between discharged patients and patients who died. The time interval from collapse to arrival at the emergency department in discharged patients and patients who went to the intensive care unit was shorter than that of patients who died in the emergency department with and without ROSC.


CONCLUSIONS
We cannot decide to give up and terminate resuscitation in any PT-CPA patients and cannot define salvageable patients. However, our data show that 30-min resuscitation is thought to be relevant and that we should not give up on resuscitation because of the time interval without ROSC after arrival at the hospital.
Moriwaki
Yoshihiro
Y
Critical Care and Emergency Center, Yokohama City University Medical Center, Yokohama, Japan. qqc3@yokohama-cu.ac.jp
Sugiyama
Mitsugi
M
Toyoda
Hiroshi
H
Kosuge
Takayuki
T
Tahara
Yoshio
Y
Suzuki
Noriyuki
N
D016887:Cardiopulmonary Resuscitation / Q000379:methods; D003326:Coronary Circulation; D004636:Emergency Service, Hospital; D006323:Heart Arrest / Q000209:etiology* / Q000628:therapy*; D006801:Humans; D011379:Prognosis; D015996:Survival Rate; D013908:Thoracotomy; D013997:Time Factors; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications*