Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field1
- 1 February 2004
- journal article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal of the American College of Surgeons
- Vol. 198 (2), 227-231
- https://doi.org/10.1016/j.jamcollsurg.2003.10.012
Abstract
Survival for trauma patients who receive prehospital cardiopulmonary resuscitation (CPR) has been reported as poor. We assessed the survival for prehospital CPR in our trauma system and attempted to find prehospital predictors of mortality. We conducted a retrospective review of our Level I trauma center's database that identified 588 patients over a 6-year period (January 1, 1997, to December 31, 2002) who received prehospital CPR. Mechanisms of injury, prehospital vital signs, and survival to discharge were analyzed. Twenty-two of 588 patients (3.7%) survived to hospital discharge. Overall, 60.7% did not survive to achieve hospital admission, and an additional 32.6% died on the first hospital day. Patients with penetrating injuries had a significantly lower survival rate than those with either blunt or other (eg, drowning, hanging) injuries (0.9% versus 6.2%, and 13.2%, respectively, p < 0.001) and significantly lower Revised Trauma Scores (RTS; mean ± SD: 0.32 ± 0.96 versus 0.76 ± 1.84 and 1.18 ± 2.51, respectively, p < 0.05.) The likelihood of survival with RTS = 0 was less than 1% overall, and 0% for penetrating trauma. These findings add support to recent guidelines regarding the termination or withholding of resuscitation for trauma patients in the prehospital setting. Victims of penetrating trauma with a prehospital RTS = 0 (combination of no respiratory rate, no systolic blood pressure, and a Glasgow Coma Score of 3) should be declared “dead at the scene.”This publication has 28 references indexed in Scilit:
- P REDICTING S URVIVAL IN P EDIATRIC T RAUMA P ATIENTS R ECEIVING C ARDIOPULMONARY R ESUSCITATION IN THE P REHOSPITAL S ETTINGPrehospital Emergency Care, 2001
- Cardiac arrest induced by blunt trauma in childrenPediatric Emergency Care, 1999
- Prehospital Pulseless, Unconscious Penetrating Trauma VictimsJournal Of Trauma-Injury Infection and Critical Care, 1998
- Survival after prehospital advanced life support in severe traumaEuropean Journal of Emergency Medicine, 1995
- PREHOSPITAL TRAUMATIC CARDIAC ARRESTJournal Of Trauma-Injury Infection and Critical Care, 1993
- Criteria for dead-on-arrivals, prehospital termination of CPR, and do-not-resuscitate ordersAnnals of Emergency Medicine, 1993
- Emergency Center Thoracotomy: Impact of Prehospital ResuscitationJournal Of Trauma-Injury Infection and Critical Care, 1992
- EMERGENCY CENTER THORACOTOMYJournal Of Trauma-Injury Infection and Critical Care, 1991
- The Major Trauma Outcome StudyJournal Of Trauma-Injury Infection and Critical Care, 1990
- Prehospital Advanced Trauma Life Support for Critical Penetrating Wounds to the Thorax and AbdomenJournal Of Trauma-Injury Infection and Critical Care, 1985