Prediction of outcome after resuscitation in a case of electrocution

Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile

INTRODUCTION

The use of guidelines regarding the termination or withholding of cardiopulmonary resuscitation (CPR) in traumatic cardiac arrest patients remains controversial. This study aimed to describe the outcomes for victims of penetrating and blunt trauma who received prehospital CPR.

METHODS

We conducted a retrospective review of a statewide major trauma registry using data from 2001 to 2004. Subjects suffered penetrating or blunt trauma, received CPR in the field by paramedics and were transported to hospital. Demographics, vital signs, injury severity, prehospital time, length of stay and mortality data were collected and analysed.

RESULTS

Eighty-nine patients met inclusion criteria. Eighty percent of these were blunt trauma victims, with a mortality rate of 97%, while penetrating trauma patients had a mortality rate of 89%. The overall mortality rate was 95%. Sixty-six percent of patients had a length of stay of less than 1 day. Four patients survived to discharge, of which two were penetrating and two were blunt injuries. Hypoxia and electrical injury were probable associated causes of two cardiac arrests seen in survivors of blunt injury.

CONCLUSIONS

While only a small number of penetrating and blunt trauma patients receiving CPR survived to discharge, this therapy is not always futile. Prehospital emergency personnel need to be aware of possible hypoxic and electrical causes for cardiac arrest appearing in combination with traumatic injuries.

Successful cardiopulmonary resuscitation outcome reviews

An implicit question in every pre-hospital cardiopulmonary resuscitation (CPR) scenario is 'what will be the quality of life if a save is achieved?' This issue has implications for doctrine, policy, training and post-CPR counselling of both resuscitator and victim. Post-salvage neurological syndromes in surviving victims include amnesia, personality change, cognitive loss, depression, Parkinsonian syndromes, decorticate and decerebrate states and permanent brain damage with vegetative existence. Children who are salvaged by CPR rarely have pre-existing co-morbidities; but 75% of adults have pre-existing cardiac disease, cancer or diabetes. Such, of course, continue after a successful resuscitation. In the case of children who are resuscitated from acute hypoxic insults, the quality of life is generally good and, in the specific instance of survivors from near-drowning, some 95% will lead lives relatively unmodified. Although successful CPR resuscitation rates remain low in adults, the quality of life of those who leave hospital remains generally high. CPR involves two feature subjects, the resuscitator and the victim. Just as for the victim, so too the resuscitator's life is modified by CPR and its aftermath, whether immediate salvage has been achieved or not. This review addresses these issues, as a successful CPR (dramatic as it is) is not a conclusion but the beginning of a new phase of life for both resuscitator and victim.