Outcomes from prehospital cardiac arrest in blunt trauma patients.
BACKGROUND
There are few strategies for treating patients who have suffered cardiopulmonary arrest due to blunt trauma (BT-CPA). The aim of this population-based case series observational study was to clarify the outcome of BT-CPA patients treated with a standardized strategy that included an emergency department thoracotomy (EDT) under an emergency medical service (EMS) system with a rapid transportation system.


METHODS
The 477 BT-CPA registry data were augmented by a review of the detailed medical records in our emergency department (ED) and action reports in the prehospital EMS records.


RESULTS
Of those, 76% were witnessed and 20% were CPA after leaving the scene. In all, 18% of the patients went to the intensive care unit (ICU), the transcatheter arterial embolization (TAE) room, or the operating room (OR). Only 3% survived to be discharged. Among the 363 witnessed patients-11 of whom had ventricular fibrillation (VF) as the initial rhythm, 134 exhibiting pulseless electrical activity (PEA), and 221 with asystole-13, 1, and 3%, respectively, survived to discharge. The most common initial rhythm just after collapse was not VF but PEA, and asystole increased over the 7 min after collapse. There were no differences in the interval between arrival at the hospital and the return of spontaneous circulation between the patients that survived to discharge and deceased patients in the ED, OR, TAE room, or ICU. The longest interval was 17 min.


CONCLUSIONS
In BT-CPA patients, a 20-min resuscitation effort and termination of the effort are thought to be relevant. The initial rhythm is not a prognostic indicator. We believe that the decision on whether to undertake aggressive resuscitation efforts should be made on a case-by-case basis.
Moriwaki
Yoshihiro
Y
Critical Care and Emergency Center, Yokohama City University, Medical Center 4-57 Urafune-cho, Minami-ku, Yokohama, 232-0024, Japan. qqc3@urahp.yokohama-cu.ac.jp
Sugiyama
Mitsugi
M
Yamamoto
Toshiro
T
Tahara
Yoshio
Y
Toyoda
Hiroshi
H
Kosuge
Takayuki
T
Harunari
Nobuyuki
N
Iwashita
Masayuki
M
Arata
Shinju
S
Suzuki
Noriyuki
N
D000328:Adult; D000368:Aged; D016887:Cardiopulmonary Resuscitation; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services / Q000458:organization & administration*; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000601:surgery*; D006801:Humans; D007564:Japan; D008297:Male; D008875:Middle Aged; D012042:Registries; D015996:Survival Rate; D013908:Thoracotomy; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000150:complications / Q000401:mortality / Q000601:surgery*