Abstract
BackgroundThe effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED).MethodsA retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders.ResultsA total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42–2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02–1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13–2.42], p = 0.009).ConclusionsCompared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.
Highlights
The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable
We evaluated the effectiveness of OCCPR, compared to closed-chest cardiopulmonary resuscitation (CCCPR), in trauma patients who had signs of life (SOL) upon emergency department (ED) admission, based on the hypothesis that OCCPR is associated with better survival outcomes than CCCPR in those patients
The OCCPR group was older than the CCCP R group, and the proportion of blunt trauma was higher in the OCCPR group (71.8%) than in the CCCPR group (42.7%)
Summary
The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Open-chest cardiopulmonary resuscitation (OCCPR) came into use in the USA in the late 1800s as the salvage maneuver following cardiac arrest. It simultaneously includes control of infra diaphragmatic hemorrhage by cross-clamping of the descending thoracic aorta, in addition to direct cardiac massage, when necessary [1, 2]. The indications for RT in those guidelines are generally based upon a positive finding of signs of life (SOL: detectable blood pressure, respiratory or motor effort, cardiac electrical activity, or pupillary activity) and the time from onset of cardiac arrest because patient survival is believed to be rare after more than 15 min of cardiopulmonary resuscitation [11].
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