1. Contillo, Christine RN
  2. Kayyali, Andrea MSN, RN
  3. Cutugno, Christine PhD, RN

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According to this study:


* Survival rate and neurologic outcomes are similar in trauma patients who suffer cardiac arrest out of the hospital and in those in whom cardiac arrest is caused by medical reasons.



It has long been assumed that the prognosis of trauma victims who suffer cardiac arrest outside the hospital is dismal. Consequently, the guidelines of the National Association of EMS Physicians-American College of Surgery Committee on Trauma and the protocols for advanced trauma life support discourage resuscitating blunt-trauma patients who have cardiac arrest outside the hospital or penetrating-trauma victims found to be pulseless, apneic, or without signs of life. Researchers sought to find out whether the prognosis really is worse in trauma victims than in nontrauma (medical) patients who suffer cardiac arrest and undergo resuscitation outside the hospital.


The researchers considered data of the European Epinephrine Study Group trial, in which patients suffering cardiac arrest outside the hospital were randomly assigned to receive repeated high doses (5 mg each) or standard doses (1 mg each) of epinephrine at three-minute intervals and advanced cardiac and trauma life support. Only patients who regained cardiac activity were transported to a hospital. It was found that survival rate and neurologic outcome were comparable in the two groups.


Medical patients who have a cardiac arrest outside the hospital more frequently suffer ventricular fibrillation followed by asystole. On the other hand, trauma patients can suffer asystole as the initial arrhythmia as a result of hypoxia or hypovolemia caused by the trauma. Therefore, even though asystole is usually a dire sign, the initial cardiac rhythm does not necessarily determine the outcome of care and should not be the factor that determines whether care is provided.


The authors also note the French prehospital system allows for more intensive treatment before transport, resulting in 30% of trauma victims and 24% of medical patients surviving to admission.


The authors conclude that the benefit of resuscitation after traumatic cardiac arrest outside the hospital should not be discounted and that the decision to perform it should not be based on the initial cardiac rhythm.


C. Contillo


David JS, et al. Crit Care Med 2007;35(10):2251-5.