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The Consequences of Noncompliance With Guidelines for Withholding or Terminating Resuscitation in Traumatic Cardiac Arrest Patients

Mollberg, Nathan M. DO; Wise, Stephen R. MD; Berman, Kevin MD; Chowdhry, Saeed MD; Holevar, Michelle MD; Sullivan, Ryan MD; Vafa, Amir MD

The Journal of Trauma: Injury, Infection, and Critical Care: October 2011 - Volume 71 - Issue 4 - p 997-1002
doi: 10.1097/TA.0b013e3182318269
Original Article

Background: The validity of current guidelines regarding resuscitation of patients in traumatic cardiopulmonary arrest (TCPA) and the ability of emergency medical services (EMS) to appropriately apply them have been called into question. The purpose of this study is to demonstrate the consequences of violating the current published guidelines and whether EMS personnel were able to accurately identify patients in TCPA.

Methods: We conducted a retrospective review of our Level I trauma center's database that identified 294 patients over an 8-year period (January 1, 2003, to December 31, 2010) who suffered prehospital TCPA and met criteria for the withholding or termination of resuscitation based on current guidelines. Patient demographics, prehospital/emergency department physiology, survival, neurologic outcome, and hospital charges were analyzed.

Results: One of 294 patients (0.3%) survived to reach hospital discharge with a Glasgow Coma Scale score of 6. The total costs incurred for these 294 patients meeting criteria for withholding or termination of resuscitation were $3,852,446.65. One hundred seventeen (39.8%) patients were evaluated by more than one EMS team. There was 100% agreement on the presence (15 of 15) or absence (102 of 102) of a pulse between the EMS teams.

Conclusions: Our data support the current guidelines regarding the withholding or termination of resuscitation of patients in prehospital TCPA and represent the largest series to date on this topic. EMS personnel were able to accurately determine traumatic cardiac arrest in the field in this series. Violation of the current guidelines resulted in six patients being resuscitated to a neurologically devastated state. No loss of neurologically intact survivors would have resulted had strict adherence to the guidelines been maintained.

From the Division of General Surgery (N.M.M., S.R.W., K.B., S.C.) and Division of Trauma (M.H., R.S., A.V.), Department of Surgery, University of Illinois at Mount Sinai Hospital, Chicago, Illinois.

Submitted for publication June 28, 2011.

Accepted for publication August 5, 2011.

Presented at the Annual Meeting for the Chicago Committee on Trauma, September 10, 2010, Chicago, Illinois; the Annual Meeting for the Region 5 Committee on Trauma, October 27, 2010, Bloomington, Minnesota; and the 89th Annual Meeting of the American College of Surgeons Committee on Trauma, March 10, 2011, Washington, District of Columbia.

Address for reprints: Nathan Mollberg, DO, Department of Surgery, Mt. Sinai Hospital, 15th at California Avenue, Chicago, IL 60608; email:

© 2011 Lippincott Williams & Wilkins, Inc.