Improved survival among hospitalized trauma patients is showing increasing trends; however, death following Traumatic Cardiac Arrest (TCA) remains the most expected outcome. A new systematic review confirmed a 96.7% mortality rate for adult patients with TCA. The most ordinarily observed cardiac electrical rhythms associated with TCA are asystole and Pulseless Electrical Activity (PEA); the latter is more common, and both are associated with poor prognosis. However, pulseless electrical activity is thought to be a sign of life, rather than death, encouraging resuscitation efforts.
This study aimed to investigate up-to-date experiences with TCA to determine if patients who presented with PEA alone had a better prognosis as compared to those who presented with asystole and assess the utility of CWM (cardiac wall movement) p-FAST to direct termination vs continuation of resuscitation in context with patient survival. The study generated the hypothesis that patients with PEA are likely to have lower mortality than those in asystole and that the appearance of CWM would be connected to survival.
Methods: The study recognized patients undergoing pre-hospital CPR from the registries of two level-1 trauma centres of American College of Surgeons. Advanced life support protocols guided pre-hospital management by emergency medical transport services. All patients who had experienced TCA and received CPR before hospitalization were included.
Results: Of 277 patients who underwent pre-hospital CPR, 110 patients had PEA on arrival to the Emergency Department while 147 had asystole. 69 (62.7%) were injured by blunt mechanisms. The study found median CPR duration to be 20.0 and 8.0 min for pre-hospital and ED, respectively. Sixty-three patients (22.7%) underwent resuscitative thoracotomy. One hundred seventy-two patients (62.1%) received CUS, and of these, 32 (18.6%) had CWM. CWM was significantly correlated with survival to hospital admission). In the overall study, only one patient survived PEA.
Conclusion:The researchers thus found that PEA on arrival predicts death. However, cardiac wall movement is correlated with survival to admission; it is not associated with significant survival rates. Thus, heroic resuscitative measures may be wrong for PEA following prehospital traumatic arrest, unmindful of CWM.