Cardiopulmonary resuscitation after traumatic cardiac arrest - there are survivors: registries must speak about it

Care by Gräsner and colleagues that strongly emphasizes the importance of encouraging attempts at cardiopulmonary resuscitation (CPR) in cardiac arrest caused by severe trauma [1]. Despite the interesting content, in our opinion the results presented by Gräsner and colleagues suff er by being derived from databases designed for diff erent purposes (Cardiac Arrest Registry and Trauma Registry). Th e Cardiac Arrest Registry is a record ing system triggered by the code cardiac arrest, while, in presence of trauma, cardiac arrest usually represents the exit code. In our experience, cardiac arrest due to major trauma can also require extracorporeal life support (ECLS) [2]. At our tertiary referral hospital (Careggi Teaching Hospital, Florence, Italy), an ECLS algorithm-guided program has been extended to major trauma since 2009. Since then, 20 trauma patients (mean ± standard deviation age 46 ± 22 years, Injury Severity Score 57 ± 17) underwent either veno-arterial ECLS (15/20 patients) or veno-venous ECLS (5/20 patients). In 10 out of 20 trauma patients, veno-arterial ECLS was established during CPR for in-hospital cardiac arrest. Th is subgroup of trauma patients had severe injuries (mean Injury Severity Score 58.3 ± 15.4), frequently head injuries (70%) and a shock state (70%). Cardiac arrest occurred in six patients within 6 hours from the traumatic event, in one patient after 8 hours and in three patients after 24 hours. Th e overall mortality rate was 80%. Our data highlight that the lack of data from registries does not support operators in decision-making on posttraumatic cardiac arrest.