Does the prognosis of cardiac arrest differ in trauma patients?*

Abstract

Objective: 

It is proposed to not resuscitate trauma patients who have a cardiac arrest outside the hospital because they are assumed to have a dismal prognosis. Our aim was to compare the outcome of patients with traumatic or nontraumatic (“medical”) out-of-hospital cardiac arrest.

Design: 

Cohort analysis of patients with out-of-hospital cardiac arrest included in the European Epinephrine Study Group’s trial comparing high vs. standard doses of epinephrine.

Setting: 

Nine French university hospitals.

Patients: 

A total of 2,910 patients.

Interventions: 

Patients were successively and randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at 3-min intervals.

Measurements and Main Results: 

Return of spontaneous circulation, survival to hospital admission and discharge, and secondary outcome measures of 1-yr survival and neurologic outcome were recorded. In the trauma group, patients were younger (42 ± 17 vs. 62 ± 17 yrs, p < .001), presented with fewer witnessed out-of-hospital cardiac arrests (62.3% vs. 79.7%), and had fewer instances of ventricular fibrillation as the first documented pulseless rhythm (3.4% [95% confidence interval, 1.2–5.5%] vs. 17.3% [15.8–18.7%]). A return of spontaneous circulation was observed in 91 of 268 trauma patients (34.0% [28.3–39.6%]) compared with 797 of 2,642 medical patients (30.2% [28.4–31.9%]), and more trauma patients survived to be admitted to the hospital (29.9% [24.4–35.3%] vs. 23.5% [22.0–25.2%]). However, there was no significant difference between trauma and medical groups at hospital discharge (2.2% [0.5–4.0%] vs. 2.8% [2.1–3.4%]) and 1-yr survival (1.9% [0.3–3.5%] vs. 2.5% [1.9–3.1%]). Among patients who were discharged, a good neurologic status was observed in two trauma patients (33.3% [4.3–77.7%]) and 37 medical patients (50% [38.1–61.9%]).

Conclusions: 

The survival and neurologic outcome of out-of-hospital cardiac arrest were not different between trauma and medical patients. This result suggests that, under the supervision of senior physicians, active resuscitation after out-of-hospital cardiac arrest is as important in trauma as in medical patients.