(216) Pulseless on Arrival: Outcomes for the Trauma Patient After Cardiopulmonary Resuscitation

Introduction: The pulseless trauma patient’s arrival to the trauma bay presents medical challenges and often fruitless efforts. Despite previous claims that resuscitation attempts are futile, advances in both damage control resuscitation and the understanding of pathophysiological differences based on traumatic mechanism have led to many survivors. This study sought to assess patient outcomes after presenting pulseless based on blunt or penetrating traumatic mechanisms.

Methods: A retrospective review of the National Trauma Database from 2017-2018 was conducted. All patients who were pulseless on arrival (pulse = 0) or had a cardiac arrest without pre-hospital cardiopulmonary resuscitation were included. Patients transferred to other hospitals or left against medical advice were excluded. These patients were divided into blunt or penetrating injuries, and these groups were compared by emergency department (ED) discharge disposition designations, length of stay, and survival rates.

Results: Mortality rate at initial presentation was 90%, with no difference between blunt or penetrating mechanisms (p = .51) and 6% of all patients received in-hospital CPR. Interestingly, 9.5% of penetrating injuries and 9.8% of blunt traumas had post-ED dispositions. Of patients admitted to the OR or ICU, 73% and 82% did not receive CPR (p <.001). Ten-hour and ten-day survival varied based on mechanism and administration of CPR and merits further investigation.

Conclusions: Pulselessness on arrival has a grave prognosis. However, there were more patients admitted to the OR or ICU who did not receive CPR, which indicates that CPR in this specific trauma population may not be necessary and has the potential to delay appropriate care.