Prehospital Cardiopulmonary Resuscitation of the Critically Injured Patient.

Copass MK, Oreskovich MR, Bladergroen MR, Carrico CJ American Journal of Surgery 1984 Vol. 148 Pages 20-26

The authors feel that the pendulum has shifted away from the concept of field stabilization towards scoop and run. The purpose of their study was to review the experience of the Seattle paramedic system for trauma victims in cardiopulmonary arrest. Over a three year period, the system transported 5,761 injured patients to the same trauma centre. 131 of these patients required cardiopulmonary resuscitation. The analysis compared survivors to non-survivors. Both groups of patients were equally young (mean age 28:34 years) and the ratio of male to female was equal (2:1) in the two groups. Transport time to hospital was also virtually identical. Of significant difference was the fact that 60% of the survivors had sustained penetrating injuries whereas 95% of the non-survivors had blunt injuries. The surviving patients were clearly separated by having a tenfold higher incidence of penetrating injury. In total, 23/30 survivors had injury to the chest: 13/30 had cardiac injury, 11 with stab or gunshot wounds to the heart, 2 with blunt cardiac rupture, 4 with injury to the thoracic aorta, and 6 with penetrating injuries to the trachea or lung. 29/30 surviving patients had successful placement of an endotracheal tube vs. only two-thirds of the non-survivors. At least two IV lines (Lactated Ringers) were in place in all of the survivors vs. only 70% of the non-survivors. The authors conclude that prehospital cardiopulmonary resuscitation combined with endotracheal intubation, vigorous fluid resuscitation, and rapid transport, can be effective in resuscitating trauma patients in cardiopulmonary arrest. Survival does not correlate with the injury severity score or transport time once the patient has arrested, but does correlate with the mechanism of injury, endotracheal intubation, and placement of intravenous lines.