Abstract
BackgroundAlthough open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage maneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the descriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness of OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED).MethodsA nationwide registry-based, retrospective cohort study was conducted. Patients with blunt trauma, undergoing cardiopulmonary resuscitation (CPR) in an ED between 2004 and 2015 were identified and divided into OCCPR and CCCPR groups. Their outcomes (survival to hospital discharge and survival over 24 hours following ED arrival) were compared with propensity score matching analysis and instrumental variable analysis.ResultsA total of 6510 patients (OCCPR, 2192; CCCPR, 4318) were analyzed. The in-hospital and 24-hour survival rates in OCCPR patients were 1.8% (40/2192) and 5.6% (123/2192), and those in CCCPR patients were 3.6% (156/4318) and 9.6% (416/4318), respectively. In the propensity score-matched subjects, OCCPR patients (n = 1804) had significantly lower odds of survival to hospital discharge (odds ratio (95% CI)) = 0.41 (0.25–0.68)) and of survival over 24 hours following ED arrival (OR (95% CI) = 0.59 (0.45–0.79)) than CCCPR patients (n = 1804). Subgroup analysis revealed that OCCPR was associated with a poorer outcome compared to CCCPR in patients with severe pelvis and lower extremity injury.ConclusionsIn this large cohort, OCCPR was associated with reduced in-hospital and 24-hour survival rates in patients with blunt trauma. Further comparisons between OCCPR and CCCPR using additional information, such as time course details in pre-hospital and ED settings, anatomical details regarding region of injury, and neurological outcomes, are necessary.
Highlights
Open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage maneuver in critically injured patients, evidence on the effectiveness of open-chest cardiopulmonary resuscitation (OCCPR) has been based only on the descriptive studies of limited numbers of cases or expert opinions
Of the propensity-scorematched subjects, the proportion of patients surviving to hospital discharge in the OCCPR and closed-chest cardiopulmonary resuscitation (CCCPR) groups were 1.2% (22/1804) and 3.3% (60/1804), respectively
The two-way least-squares analysis with this instrumental variable did not alter the original analysis by propensity score matching (mean difference = –5.0% (−9.2, –0.8) for survival to hospital discharge and mean difference = –5.6% (−12.3, 1.1) for survival over 24 hours after emergency department (ED) arrival, respectively; Table 3). In this nationwide trauma registry, we evaluated the comparative effectiveness of OCCPR in the ED with that of CCCPR in patients with blunt trauma, adjusting for the available patient characteristics
Summary
Open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage maneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the descriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness of OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED). Endo et al Critical Care (2017) 21:169 patients with blunt trauma when undergoing OCCPR [9,10,11], it is important to note that there are several case reports suggesting that OCCPR may be effective in patients with blunt trauma [12, 13]. Most of aforementioned evidence on EDT is based on descriptive studies of a limited number of patients, and the comparative effectiveness of OCCPR and closed-chest cardiopulmonary resuscitation (CCCPR) has remained unclear
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
