title: Is 15 minutes an appropriate resuscitation duration before termination of a traumatic cardiac arrest? A case-control study.
abstract: BACKGROUND
  Previous guidelines suggest up to 15 minutes of cardiopulmonary resuscitation (CPR) accompanied by other resuscitative interventions before terminating resuscitation of a traumatic cardiac arrest. The current study evaluated the duration of CPR according to outcome using the model of a county-based emergency medical services (EMS) system in Taiwan.
  
  
  METHODS
  This study was performed as a prospectively defined retrospective review from EMS records and cardiac arrest registration between June 2011 and November 2012 in Taoyuan, Taiwan.
  
  
  RESULTS
  A total of 396 patients were enrolled. Among the blunt injuries, most incidents were traffic accidents (66.5%) followed by falls (31.5%). Bystander CPR was performed in 34 patients (8.6%). Of the patients, 18.4% were sent to intermediate to advanced level traumatic care hospitals. Although 4.8% of patients survived for 24 hours, only 2.3% survived to discharge, and 0.8% achieved cerebral performance category 1 or 2. Among all patients who developed return of spontaneous circulation (ROSC), 14.3% of ROSC was achieved within 15 minutes since CPR. Except for 1, most patients who developed ROSC over 24 hours but did not survive to discharge received CPR more than 15 minutes. Four of 6 patients who survived to discharge achieved ROSC after CPR for more than 15 minutes (16, 18, 22, and 24 minutes). Three patients discharged with cerebral performance category 1 or 2 received CPR for 6, 16, and 18 minutes, respectively.
  
  
  CONCLUSIONS
  Fifteen minutes of CPR before terminating resuscitation is inappropriate for patients undergoing traumatic cardiac arrsests, as longer duration resuscitation increases ROSC and survival.
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taipei, Taiwan. Electronic address: rainccy217@gmail.com.
authors.forename: Cheng-Yu
authors.initials: CY
authors.lastname: Chien
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan. Electronic address: Zabrina0316@gmail.com.
authors.forename: Yi-Chia
authors.initials: YC
authors.lastname: Su
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan; Department of Emergency Medicine, Chang Gung Memorial Hospital, Keelung, Taiwan. Electronic address: phenoca@gmail.com.
authors.forename: Chi-Chun
authors.initials: CC
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan. Electronic address: erawei@gmail.com.
authors.forename: Chan-Wei
authors.initials: CW
authors.lastname: Kuo
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Taipei, Taiwan. Electronic address: newyorker@adm.cgmh.org.tw.
authors.forename: Shen-Che
authors.initials: SC
authors.lastname: Lin
authors.affiliation: Department of Emergency Medicine, Chang Gung Memorial Hospital, and Chang Gung University College of Medicine, Linkou, Taiwan. Electronic address: wengym33@gmail.com.
authors.forename: Yi-Ming
authors.initials: YM
authors.lastname: Weng
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000401:mortality / Q000592:standards / Q000706:statistics & numerical data*; D016022:Case-Control Studies; D004632:Emergency Medical Services / Q000379:methods / Q000592:standards / Q000706:statistics & numerical data*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D058687:Out-of-Hospital Cardiac Arrest / Q000401:mortality* / Q000628:therapy; D017063:Outcome Assessment, Health Care / Q000706:statistics & numerical data; D012042:Registries; D012189:Retrospective Studies; D016019:Survival Analysis; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors