Is Pre-Hospital CPR a Risk Factor for Early Death in Patients Transferred to an Adult Burn Center?

Abstract

Burn patients who require CPR before admission to a burn center are anecdotally known to suffer higher mortality than those who do not require pre-hospital CPR. A retrospective chart review identified adult patients admitted to our burn center between 2013 and 2015. Included patients met 1 or both of the following criteria: 20% or more total body surface area burned and need for intubation before admission to our facility. We sought to identify predictors of early death, late death, and survival among burn patients who underwent CPR before admission. Of the 80 patients meeting inclusion criteria, 17.5% underwent CPR before arrival at our facility. Seventy-nine percent of these died, compared with 29% of the patients who did not require CPR (p= 0.0005). Seventy-one percent of CPR patients died within 48 hours of admission, compared with 8% of non-CPR patients (p < 0.0001). The major predictor of death vs survival after CPR was lower initial arterial pH. Patients who undergo CPR before transfer to a burn center are at high risk for early death. Predictors of death and early death after CPR may include elevated initial lactate and lower initial arterial pH.