Cardiopulmonary resuscitation traumatic cardiac national emergency registries

نویسندگان

  • Jan-Thorsten Gräsner
  • Jan Wnent
  • Stephan Seewald
  • Patrick Meybohm
  • Matthias Fischer
  • Thomas Paffrath
  • Arasch Wafaisade
  • Berthold Bein
  • Rolf Lefering
چکیده

Introduction: Cardiac arrest following trauma occurs infrequently compared with cardiac aetiology. Within the German Resuscitation Registry a traumatic cause is documented in about 3% of cardiac arrest patients. Regarding the national Trauma Registry, only a few of these trauma patients with cardiac arrest survive. The aim of the present study was to analyze the outcome of cardiopulmonary resuscitation (CPR) after traumatic cardiac arrest by combining data from two different large national registries in Germany. Methods: This study includes 368 trauma patients (2.8%) out of 13,329 cardiac arrest patients registered within the Resuscitation Registry, whereby 3,673 patients with a cardiac cause and successful CPR served as a cardiac control group. We further analyzed a second group of 1,535 trauma patients with cardiac arrest and early CPR registered within the Trauma Registry, whereby a total of 25,366 trauma patients without any CPR attempts served as a trauma control group. The relative frequencies from each database were used to calculate relative percentages for patients with traumatic cardiac arrest in whom resuscitation was attempted. Results: Within the Resuscitation Registry, cardiac arrest was present in 331 patients (89.9%) when the EMS personal arrived at the scene and in 37 patients (10.1%) when cardiac arrest occurred after arrival. Spontaneous circulation could be achieved in 107 patients (29.1%). A total of 101 (27.4%) were transferred to hospital, 95 of whom (25.8%) had return of spontaneous circulation (ROSC) on admission. According to the Trauma Registry, the overall hospital mortality rate for cardiac arrest patients following trauma was 73% (n = 593 of 814). About half of the patients who were admitted alive to hospital died within 24 hours, resulting in 13% survivors within 24 hours. 7% of the patients survived until hospital discharge, and only 2% of the patients had good neurological outcome. Conclusions: Our present study encourages CPR attempts in cardiac arrest patients following severe trauma. When a manageable number of patients is present, the decision on whether to start CPR or not should be done liberally, using comparable criteria as in patients with cardiac etiology. In this respect, trauma management programs that restrict CPR attempts should not be encouraged. Introduction Cardiac arrest following trauma occurs relatively rarely in comparison with cardiac or other etiologies. Within the German Resuscitation Registry (GRR) that is managed by the German Society of Anaesthesiology and Intensive Care Medicine (Deutsche Gesellschaft für Anästhesiologie und Intensivmedizin, DGAI), traumatic cause is documented in about 3% of cardiac arrest patients [1]. Pre-hospital cardiopulmonary resuscitation (CPR) is performed infrequently in patients with severe trauma. The Trauma Registry of the German Society for Trauma Surgery (Deutsche Gesellschaft für Unfallchirurgie, TRDGU) registers patients who had severe injuries with a * Correspondence: [email protected] Department of Anaesthesiology and Intensive Care Medicine, University Hospital Schleswig-Holstein, Campus Kiel, Schwanenweg 21, Kiel, 24105, Germany Full list of author information is available at the end of the article Gräsner et al. Critical Care 2011, 15:R276 http://ccforum.com/content/15/6/R276 © 2011 Gräsner et al.; licensee BioMed Central Ltd. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. potential need for intensive care and who had spontaneous circulation on admission. Approximately 3% of these severely injured patients documented within the TR-DGU received CPR attempts outside the hospital. Only a few of these patients survived [2], and only 1 out of 10 patients with pre-hospital CPR attempts achieved a good outcome [3]. There is an ongoing debate in terms of the effectiveness of CPR in trauma patients, particularly with regard to good long-term outcomes [4-6]. International trauma training courses have even suggested that no intervention should be started in cardiac arrest patients with primary asystole due to traumatic causes [3]. Several factors are known to influence the success of CPR. The most important factor is time. If cardiac arrest occurs during pre-hospital treatment and is observed by an emergency physician, intervention and transport should be started without any delay. Other pre-hospital factors influencing the primary goal of CPR the return of spontaneous circulation (ROSC) have recently been analyzed and identified within the GRR [7]. General prognostic factors known to influence survival after trauma, such as age, blood loss, and the severity of injury, also affect this subgroup of trauma patients. Since the TR-DGU, however, is limited to trauma patients who had spontaneous circulation at hospital admission, we now combine data from two different large national registries mentioned above the GRR and the TR-DGU to analyze the success rate of CPR after traumatic cardiac arrest in Germany. Design and publication of this study were approved by the scientific committee of the GRR and the TR-DGU in compliance with current publication guidelines. This study was approved by the ethics committee of the University of Cologne, Faculty of Medicine (Kerpener Str. 62, 50937 Cologne, Germany) (Register Number 11-014) and the ethics committee of the University of Kiel, Faculty of Medicine (Schwanenweg 20,24105 Kiel, Germany) (Register Number D456/11). Materials and methods German Resuscitation Registry (GRR) The GRR currently represents 51 emergency medical systems that record data on out-of-hospital CPR attempts throughout the country, covering a population of nine million citizens (the total population of Germany is 85 million). Participation is voluntary. In Germany, emergency medical systems (EMS) are staffed by emergency physicians from several medical specialties (mainly anesthesiology, surgery, and internal medicine) who had additional training in emergency medicine. The registry is organized and funded by the DGAI [8]. The GRR is divided into two different data sets. Firstly, a ‘preclinical care’ data set derived from the Utstein-style template for uniform reporting of cardiac arrest, aiming at documentation of pre-hospital logistic issues, presumed aetiology, resuscitation therapy and the patient’s initial outcome, including 118 variables. Secondly, the ‘post-resuscitation care’ data set is aimed at documenting in-hospital post-resuscitation efforts. Due to the anonymity of data collection and the fact that the primary purpose of the GRR is quality control, patient consent was not necessary [1]. ROSC was defined as a palpable pulse for more than 20 seconds [9,10]. Admission to hospital (ATH) was regarded as a positive outcome if circulation was still present on hospital admission (group AGRR). Failure of pre-hospital ROSC or ongoing CPR on admission was defined as a negative outcome (no ROSC/no ATH; group B). Within the GRR 13,329 out-of-hospital cardiac arrest patients were prospectively documented between 1998 and 2010 for which a professional pre-hospital EMS team was requested by dispatchers. The present study includes 368 patients (2.8%) with cardiac arrest most probably due to traumatic cause; 3673 cardiac arrest patients with a cardiac cause and with ROSC at hospital admission served as a ‘cardiac control group’ (group C). Patients from the GRR were divided into the following three groups: • group AGRR: pre-hospital CPR with ATH (n = 95) • group B: pre-hospital CPR without ROSC/ATH (n = 273) • group C: cardiac control group with ROSC (n = 3,673). Trauma Registry of the German Society for Trauma

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تاریخ انتشار 2012