AP027 Resuscitation in EMS-witnessed prehospital traumatic cardiac arrest

Abstract

Background: Prehospital traumatic cardiac arrest (TCA) is undoubtedly associated with poor prognosis. The subgroup of patients with detectable vital signs (VS) upon Emergency Medical Services (EMS) arrival and a subsequent EMS-witnessed TCA is of special interest, since it might be associated with better outcome. Materials and Methods: Sixty patients with EMS-witnessed prehospital TCA (Male/Female: 45/15, Mean age: 34.0±21.4 years, Median age: 25 years) were managed by EMS physicians in the area of Thessaloniki during a 10-year period (01.01.1995–31.12.2004). All patients had palpable carotid pulse and organized ECG activity upon EMS arrival and suffered a subsequent, at the scene or during transport, EMS-witnessed TCA. Results: Mean EMS arrival time was 8.3±5.5 min. All patients but one, suffered blunt trauma. Palpable peripheral pulse was detected in 22 (36.67%) cases. Initial median GCS score was 6 (3–15). Pupils were found normal sized in 39 (65.0%) and dilated in 21 (35.0%) patients. Pupillary reflexes were present in 21 (35.0%) patients. During cardiopulmonary resuscitation, all patients received Advanced Life Support interventions by means of endotracheal intubation, fluid resuscitation and chest tube drainage as appropriate. In 25 (41.67%) cases, resuscitation efforts were terminated before arrival at hospital. In total, 35 (58.33%) patients exhibited return of spontaneous circulation. Thirty-two (53.33%) of them died, 12 in the Emergency Department, 17 in the Operating Room and 3 in the Intensive Care Unit. Finally, 3 (5.0%) patients survived to hospital discharge, but only 1 (1.67%) – suffering penetrating neck trauma – with full neurological recovery. Autopsy causes of death revealed severe isolated or multiple organ injuries. Conclusions: The results of our study are in accordance to other similar literature studies and confirm the extremely poor survival rate after TCA. Moreover, resuscitation, even in EMS-witnessed TCA, seems to be in the majority of the cases futility.