title: Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin.
abstract: BACKGROUND
  Despite continuous innovation in trauma care, fatal trauma remains a significant medical and socioeconomic problem. Traumatic cardiac arrest (tCA) is still considered a hopeless situation, whereas management errors and preventability of death are neglected. We analyzed clinical and autopsy data from tCA patients in an emergency-physician-based rescue system in order to reveal epidemiologic data and current problems in the successful treatment of tCA.
  
  
  METHODS
  Epidemiological and autopsy data of all unsuccessful tCPR cases in a one-year-period in Berlin, Germany (n=101, Group I) and clinical data of all cases of tCPR in a level 1 trauma centre in an 6-year period (n=52, Group II) were evaluated. Preventability of traumatic deaths in autopsy cases (n=22) and trauma-management failures were prospectively assessed.
  
  
  RESULTS
  In 2010, 23% of all traumatic deaths in Berlin received tCPR. Death after tCPR occurred predominantly prehospital (PH;74%) and only 26% of these patients were hospitalized. Of 52 patients (Group II), 46% required tCPR already PH and 81% in the emergency department (ED). In 79% ROSC was established PH and 53% in the ED. The survival rate after tCPR was 29% with 27% good neurological outcome. Management errors occurred in 73% PH; 4 cases were judged as potentially or definitive preventable death.
  
  
  CONCLUSIONS
  Trauma CPR is beyond routine with the need for a tCPR-algorithm, including chest/pericardial decompression, external pelvic stabilization and external bleeding control. The prehospital trauma management has the highest potential to improve tCPR and survival. Therefore, we suggested a pilot prehospital tCPR-algorithm.
authors.affiliation: Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany; Berlin-Brandenburg Center for Regenerative Therapies, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany. Electronic address: christian.kleber@charite.de.
authors.forename: C
authors.initials: C
authors.lastname: Kleber
authors.affiliation: Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: M T
authors.initials: MT
authors.lastname: Giesecke
authors.affiliation: Departement for Emergency Medicine, Charité - Universitätsmedizin Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: T
authors.initials: T
authors.lastname: Lindner
authors.affiliation: Center for Musculoskeletal Surgery, AG Polytrauma, Charité - Universitätsmedizin, Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
authors.forename: N P
authors.initials: NP
authors.lastname: Haas
authors.affiliation: Institute of Legal Medicine and Forensic Sciences, Charité - Universitätsmedizin Berlin, Turmstrasse 21 (Building N), 10559 Berlin, Germany.
authors.forename: C T
authors.initials: CT
authors.lastname: Buschmann
mesh_terms: D000328:Adult; D000465:Algorithms; D001604:Berlin; D016887:Cardiopulmonary Resuscitation; D005260:Female; D006323:Heart Arrest / Q000453:epidemiology* / Q000209:etiology / Q000517:prevention & control / Q000628:therapy*; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D008875:Middle Aged; D011446:Prospective Studies; D015996:Survival Rate; D014947:Wounds and Injuries / Q000150:complications
keywords: Algorithm; Cardiopulmonary resuscitation; Management errors; Preventability; Survival; Trauma