Resuscitation Outcomes and Clinical Characteristics Based on the Initial ECG Rhythm in Prehospital Traumatic Cardiac Arrest Patients

ABSTRACT

PURPOSE: The purpose of this study was to investigate the outcome of resuscitation and the clinical characteristics of patients with prehospital traumatic cardiac arrest. METHODS: We conducted a 14-year retrospective study of all pulseless patients with trauma for whom cardiopulmonary resuscitation (CPR) was initiated in an in-hospital setting during the period of January 1991 through February 2004. RESULTS: Four hundred nine patients, 287 males and 122 females, were included in this study. The mean age was 42+/-18 years (range 1-93 years). Eighty patients had pulseless electrical activity (PEA) rhythm, and three hundred twenty-nine patients had asystole rhythm on the initial ECG upon arrival at our emergency room. There were no significant differences in the interval from collapse to start of ACLS (27.1+/-33.4 min. vs 36.9+/-70.1 min., p=0.220), the duration of cardiopulmonary resuscitation (25.0+/-13.7 min. vs 26.4+/-9.9 min., p=0.394), the survival rates for more than 24 hours (5.0% vs 2.4%, p=0.221), and the number of patients discharged alive (1.3% vs 0.6%, p=0.545) between the PEA group and the asystole group. However patients in PEA group had a much higher return of spontaneous circulation (ROSC) rate than those in the asystole rhythm (52.5% vs 31.0%, p.0.001). The survival rates of narrow QRS tend to be higher than ones of wide QRS in ECG rhythm after ROSC (13.5% vs 7.4%, p=0.057). However, there was no difference in the survival discharge rate (p=0.196). There was no difference in 24 hours survival rate between the group that received defibrillation and the group that did not (0.9% vs 3.7%, p=0.099). The most common cause of death was a hemorrhagic shock. CONCLUSION: There was no difference in survival rate between the PEA and the asystole at an initial ECG rhythm. The overall survival rate of patients with prehospital cardiac arrest after trauma is very poor.