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Open Access Highly Accessed Research

Cardiopulmonary resuscitation traumatic cardiac arrest - there are survivors. An analysis of two national emergency registries

Jan-Thorsten Gräsner1*, Jan Wnent2, Stephan Seewald1, Patrick Meybohm1, Matthias Fischer3, Thomas Paffrath4, Arasch Wafaisade4, Berthold Bein1, Rolf Lefering5 and German Resuscitation Registry Working Group, Trauma Registry of the German Society for Trauma Surgery (DGU)

Author Affiliations

1 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel, 24105, Germany

2 Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, Lübeck, 23538, Germany

3 Department of Anaesthesiology and Intensive Care, Klinikum am Eichert,Eichertstraße 3, Göppingen, 73035, Germany

4 Department of Orthopedic and Trauma Surgery, Cologne Merheim Medical Center, Ostmerheimerstr. 200, Cologne, 51109, Germany

5 Institute for Research in Operative Medicine, Faculty of Health, University of Witten/Herdecke, Alfred-Herrhausen-Straße 50, Witten, 58448, Germany

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Critical Care 2011, 15:R276  doi:10.1186/cc10558

Published: 22 November 2011

Abstract

Introduction

Cardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany.

Methods

This study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted.

Results

Within the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome.

Conclusions

Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged.