Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

Akira Endo¹, Atsushi Shiraishi^{2

3}, Yasuhiro Otomo², Makoto Tomita⁴, Hiroki Matsui⁵, Kiyoshi Murata²

Affiliations

¹ Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. eraeaccm@tmd.ac.jp.
² Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
³ Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan.
⁴ Clinical Research Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
⁵ Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.

PMID: 28673321
PMCID: PMC5496413
DOI: 10.1186/s13054-017-1759-1

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

Akira Endo et al. Crit Care. 2017.

. 2017 Jul 3;21(1):169.

doi: 10.1186/s13054-017-1759-1.

Authors

Akira Endo¹, Atsushi Shiraishi^{2

3}, Yasuhiro Otomo², Makoto Tomita⁴, Hiroki Matsui⁵, Kiyoshi Murata²

Affiliations

¹ Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan. eraeaccm@tmd.ac.jp.
² Trauma and Acute Critical Care Medical Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, 113-8510, Japan.
³ Emergency and Trauma Center, Kameda Medical Center, 929 Higashicho, Kamogawa, Chiba, Japan.
⁴ Clinical Research Center, Hospital of Medicine, Tokyo Medical and Dental University, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan.
⁵ Department of Clinical Epidemiology and Health Economics, School of Public Health, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo, Japan.

PMID: 28673321
PMCID: PMC5496413
DOI: 10.1186/s13054-017-1759-1

Abstract

Background: Although 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).

Methods: A 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.

Results: A 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.

Conclusions: In 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.

Keywords: Cardiac arrest; Emergency thoracotomy; Polytrauma; Registry; Resuscitation; Shock.

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The authors declare that they have no competing interests.

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Figures

**Fig. 1**
Patient selection. *JTDB* Japan Trauma Databank, *AIS* abbreviated injury scale, *OCCPR* open-chest cardiopulmonary resuscitation, *CCCPR* closed-chest cardiopulmonary resuscitation

**Fig. 2**
Kaplan-Meier analysis of 30-day mortality in propensity-score-matched subjects. *OCCPR* open-chest cardiopulmonary resuscitation, *CCCPR* closed-chest cardiopulmonary resuscitation

**Fig. 3**
The results of subgroup analysis for the primary outcome. Odds ratios for survival to hospital discharge [95% confidence interval] in each subgroup and p values for interaction between subgroups are presented. *OCCPR* open-chest cardiopulmonary resuscitation, *CCCPR* closed-chest cardiopulmonary resuscitation, CI confidence interval, *EMS* emergency medical services, ED emergency department, *ISS* injury severity score, *AIS* abbreviated injury scale

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Comment in

Limited evidence to recommend against open chest cardiopulmonary resuscitation in blunt trauma.
Malinverni S, Mols P. Malinverni S, et al. Crit Care. 2017 Sep 20;21(1):244. doi: 10.1186/s13054-017-1831-x. Crit Care. 2017. PMID: 28931419 Free PMC article. No abstract available.

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