Abstract
BackgroundData of the TraumaRegister DGU® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase.MethodsThe database of the TraumaRegister DGU® from 2002 to 2013 was analyzed. The main focus of this survey was on different time points of performed resuscitation.Descriptive and multivariate analyses (logistic regression) were performed with the neurological outcome (Glasgow Outcome Scale) and survival rate as the target variable. Patients were classified according to CPR in the prehospital phase and/or in the emergency room (ER). Patients without CA served as a control group. The database does not include patients who required prehospital CPR but did not achieve ROSC.ResultsA total of 3052 patients from a total of 38,499 cases had cardiac arrest during the early post-trauma phase and required CPR in the prehospital phase and/or in the ER. After only prehospital resuscitation (n = 944) survival rate was 31.7 %, and 14.7 % had a good/moderate outcome. If CPR was required in the ER only (n = 1197), survival rate was 25.6 %, with a good/moderate outcome in 19.2 % of cases. A total of 4.8 % in the group with preclinical and ER resuscitation survived, and just 2.7 % had a good or moderate outcome. Multivariate logistic regression analysis revealed the following prognostic factors for survival after traumatic cardiac arrest: prehospital CPR, shock, coagulopathy, thorax drainage, preclinical catecholamines, unconsciousness, and injury severity (Injury Severity Score).ConclusionsWith the knowledge that prehospital resuscitated patients who not reached the hospital could not be included, CPR after severe trauma seems to yield a better outcome than most studies have reported, and appears to be more justified than the current guidelines would imply. Preclinical resuscitation is associated with a higher survival rate and better neurological outcome compared with resuscitation in the ER. If resuscitation in the ER is necessary after a preclinical performed resuscitation the survival rate is marginal, even though 56 % of these patients had a good and moderate outcome. The data we present may support algorithms for resuscitation in the future.
Highlights
Data of the TraumaRegister Deutsche Gesellschaft für Unfallchirurgie (DGU)® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase
These patients had return of spontaneous circulation (ROSC) and were transported to a hospital; the number of cases with attempted but unsuccessful Cardiopulmonary resuscitation (CPR) is not documented in the TraumaRegister DGU® (TR-DGU)
Patients who were dead/who died in the field or patients or without ROSC after cardiac arrest were not included in the trauma room (TR)-DGU, according to our inclusion criteria for the registry
Summary
Data of the TraumaRegister DGU® were analyzed to derive survival rates, neurological outcome and prognostic factors of patients who had suffered traumatic cardiac arrest in the early treatment phase. Patients suffering traumatic cardiorespiratory arrest (TCRA) are generally reported to have a poor outcome [1,2,3,4,5,6,7,8,9,10,11,12]. A recent systematic review revealed that children appear to have a better chance of survival after resuscitation than adults after suffering out-of-hospital traumatic cardiac arrest, and that they tend to have a poorer neurological outcome at discharge [13]. Cardiopulmonary resuscitation (CPR) in children after severe trauma seems to yield a better outcome than in adults, and according to a recent study, appears to be more justified than the current guidelines would imply.
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