[Trauma and circulatory arrest. 224 preclinical resuscitations in Cologne in 1987-1990]

Abstract

Posttraumatic cardiopulmonary resuscitation (CPR) is associated with a poor outcome. When evaluating the literature according to the Utstein method, there were only 2 survivors (0.18%) out of 1,135 CPR attempts after trauma (Table 1). Differences in the study populations and levels of prehospital trauma care led us to analyse the results of a physician-staffed prehospital trauma care system in Cologne. METHODS. From January 1987 to December 1990, a total of 49,054 emergency calls were registered using a standardised protocol. Among 9,595 trauma-related calls, 636 patients were found to be pulseless on arrival of the emergency team, 412 of these were pronounced dead. CPR was initiated in the remaining 224 patients, who comprise the study population (defined as 100%). All patients who were admitted to a hospital were followed using a second protocol. RESULTS. CPR in the field was successful in 68 (30.4%) patients, who were then admitted to a hospital; 42 of these died within the first 24 h. Four patients (1.8%) could be discharged from hospital alive and were still living 1 year later, 1 with a lasting neurological deficit (Fig. 1). In 156 (69.6%) cases resuscitative attempts were unsuccessful in the field. CONCLUSIONS. Even in a physician-staffed prehospital trauma care system, the chance of surviving a posttraumatic cardiac arrest is minimal. Survival has to be regarded as an individual fate; the overall results are discouraging. Even though this study analyses the largest population of posttraumatic CPR ever published, prognostic factors could not be identified due to the few survivors. Nevertheless, the result does not justify general omission of CPR after trauma as: (1) prognostic factors for survival have not been identified thus far; and (2) no significant additional costs arise from posttraumatic CPR.