L. D. Raff1, P. Hu1, R. Uhlich1, J. D. Kerby1, P. L. Bosarge1 1University Of Alabama at Birmingham,Acute Care Surgery/ Surgery/Medicine,Birmingham, Alabama, USA
Introduction: The use of cardiopulmonary resuscitation (CPR) following traumatic arrest historically leads to dismal survival rates. Recently, major critical care organizations have endorsed that interventions should be considered inappropriate when there is no reasonable expectation that the patient will improve sufficiently to survive outside the acute care setting or have meaningful neurological recovery. To date, very little information has been published to suggest if patients with traumatic brain injury (TBI) benefit from CPR and what functional outcomes can be expected if the patient has return of spontaneous circulation (ROSC). The purpose of this study is to determine the outcome of patients with obvious traumatic brain injury that required CPR.
Methods: We identified all adult trauma patients that presented with traumatic cardiac arrest from June 1, 2014 to August 1, 2016. Data regarding demographics, mechanism of injury, cardiac rhythm, resuscitation duration, resuscitation procedures, blood product utilization, mortality data, and disposition from hospital were collected.
Results: Among 183 cases of CPR due to traumatic arrest, 21 were identified as having an obvious traumatic brain injury. Of those 21 patients, 18 (85.7%) had penetrating trauma to the head. The mean age was 39.7 (± 17.4) years and 38.1% were women. The median prehospital CPR time was 10 (0-50) minutes; the median hospital CPR time was 9 (0-59) minutes; and the median total CPR time was 23 (2-89) minutes. ROSC occurred in only 2 patients (9.5%) who had a median CPR time of 4 (2-6) minutes. No patient that presented in asystole had ROSC (0 of 10) versus 20% of those patients that presented in any other cardiac rhythm other than asystole (p=0.065). Of the two patients that had ROSC, both patients were subsequently declared brain dead yielding no survivors for this patient group.
Conclusion: In patients with obvious TBI that present in traumatic arrest, overall ROSC is poor. When ROSC occurs overall mortality remains high as these patients do not survive the neurological insult. When patients present in traumatic arrest with asystole, efforts to continue resuscitation should be terminated. Performance of CPR in patients with obvious TBI upon hospital presentation should be considered futile interventions.