K. Konesky1, W. Guo1 1State University Of New York At Buffalo,Surgery,Buffalo, NY, USA
Introduction: Adult trauma patients who experience immediate out-of-hospital or in-hospital cardiac arrest (CA) and undergo Advanced Cardiac Life Support (ACLS) represent a unique patient population and pose difficult challenges to trauma surgeons. Thus far little is known about the predictors and outcomes of CA in trauma patients. The objective of this study was to determine the incidence, predictors and outcomes following CA and ACLS within this population.
Methods: We retrospectively reviewed all 124 adult blunt and penetrating trauma patients who underwent ACLS after trauma over a period of 5 years (Jul 2008-Jun 2012). The ACLS occurred either in the field, en route or in the ED of our Level I Trauma Center. Patient’s demographics, clinical data, ACLS–related variables and outcomes were extracted from the electronic and paper medical records.
Results:The median age of the group was 37 (IQR 38). The median ISS was 37 (IQR 50). While 32% of patients achieved recovery of spontaneous circulation (ROSC), only 8% survived with a complete neurologic recovery (CNR). The failure rate of ACLS was 92%. In blunt injury patients, the ROSC and CNR rate after ACLS was higher in motor vehicle collisions, motorcycle and pedestrian injuries combined than falls from heights (27.3% vs 6.9%, OR 5.06, 95% CI 0.95-27.0, p<0.05). In penetrating injury, the ROSC/CNR rate after ACLS was higher in patients with injuries to the head, neck, face and extremities than those with injuries to the abdomen and chest (0% vs 25%, OR 0.051, 95% CI 0.0024-1.087, p<0.001). Two variables predicted failure of ACLS were prolonged time interval between injury and ED arrival (OR 0.42, 95% CI 0.22-0.80, p<0.01), and high ISS (OR 0.97, 95% CI 0.94-1.00, p<0.05). However, initial cardiac rhythms upon CPR (see table), ACLS duration/location (out-of-hospital or in-hospital), head injury, and day/night shifts in ED were not associated with the outcome of ACLS. The percentage of penetrating trauma was lower in patients with age≥65 y/o than those <65 y/o (11.1% vs 53.6%, p<0.001), and the ROSC/CNR rate was significantly higher in the patients ≥65 y/o than those <65 y/o (18.5% vs 5.2%, p<0.05).
Conclusion: Although survival after ACLS among trauma patients continues to be poor, advanced cardiac life support should be initiated regardless of the initial EKG rhythm. A rapid response time and taking the patients to the ED immediately is the key to the survival. A better survival rate in patients ≥65 y/o is probably due to the lower rate of penetrating injury.
