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Does the prognosis of cardiac arrest differ in trauma patients?
Jean-Stephane David1, Pierre-Yves Gueugniaud, Bruno Riou
1Department of Anesthesiology and Critical Care, Hospices Civils de Lyon, Centre Hospitalier Lyon-Sud, Pierre-Bénite, France. js-david@univ-lyon1.fr
Insights
Out-of-hospital cardiac arrest outcomes are similar for trauma and medical patients. Active resuscitation efforts are equally important for both groups, challenging assumptions of poor prognosis in trauma cases.
Area of Science:
- Emergency Medicine
- Cardiology
- Trauma Surgery
Background:
- Current practice often assumes a poor prognosis for trauma patients experiencing out-of-hospital cardiac arrest (OHCA), leading to withholding resuscitation.
- Limited comparative data exists on the outcomes of traumatic OHCA versus non-traumatic (medical) OHCA.
Purpose of the Study:
- To compare the survival and neurologic outcomes of patients with traumatic OHCA versus medical OHCA.
- To evaluate the efficacy of resuscitation strategies in trauma patients with OHCA.
Main Methods:
- A cohort analysis of 2,910 patients with OHCA was conducted across nine French university hospitals.
- Patients were enrolled in the European Epinephrine Study Group trial, comparing high-dose (5 mg) versus standard-dose (1 mg) epinephrine.
- Data collected included return of spontaneous circulation, hospital admission and discharge survival, and 1-year survival with neurologic assessment.
Main Results:
- Trauma patients were younger and less likely to have witnessed arrests or ventricular fibrillation as the initial rhythm.
- Return of spontaneous circulation (34.0% vs. 30.2%) and hospital admission (29.9% vs. 23.5%) were higher in trauma patients.
- No significant differences were observed in hospital discharge survival (2.2% vs. 2.8%) or 1-year survival (1.9% vs. 2.5%) between trauma and medical groups.
Conclusions:
- Survival and neurologic outcomes following OHCA do not significantly differ between trauma and medical patients.
- Active resuscitation should be considered for trauma patients with OHCA, similar to medical patients, under senior physician supervision.
- The study challenges the assumption of a dismal prognosis for trauma patients with OHCA, advocating for continued resuscitation efforts.
Objective:
It is proposed to not resuscitate trauma patients who have a cardiac arrest outside the hospital because they are assumed to have a dismal prognosis. Our aim was to compare the outcome of patients with traumatic or nontraumatic ("medical") out-of-hospital cardiac arrest.
Design:
Cohort analysis of patients with out-of-hospital cardiac arrest included in the European Epinephrine Study Group's trial comparing high vs. standard doses of epinephrine.
Setting:
Nine French university hospitals.
Patients:
A total of 2,910 patients.
Interventions:
Patients were successively and randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at 3-min intervals.
Measurements And Main Results:
Return of spontaneous circulation, survival to hospital admission and discharge, and secondary outcome measures of 1-yr survival and neurologic outcome were recorded. In the trauma group, patients were younger (42 +/- 17 vs. 62 +/- 17 yrs, p < .001), presented with fewer witnessed out-of-hospital cardiac arrests (62.3% vs. 79.7%), and had fewer instances of ventricular fibrillation as the first documented pulseless rhythm (3.4% [95% confidence interval, 1.2-5.5%] vs. 17.3% [15.8-18.7%]). A return of spontaneous circulation was observed in 91 of 268 trauma patients (34.0% [28.3-39.6%]) compared with 797 of 2,642 medical patients (30.2% [28.4-31.9%]), and more trauma patients survived to be admitted to the hospital (29.9% [24.4-35.3%] vs. 23.5% [22.0-25.2%]). However, there was no significant difference between trauma and medical groups at hospital discharge (2.2% [0.5-4.0%] vs. 2.8% [2.1-3.4%]) and 1-yr survival (1.9% [0.3-3.5%] vs. 2.5% [1.9-3.1%]). Among patients who were discharged, a good neurologic status was observed in two trauma patients (33.3% [4.3-77.7%]) and 37 medical patients (50% [38.1-61.9%]).
Conclusions:
The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients. This result suggests that, under the supervision of senior physicians, active resuscitation after out-of-hospital cardiac arrest is as important in trauma as in medical patients.
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