Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field1

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Abstract
Survival for trauma patients who receive prehospital cardiopulmonary resuscitation (CPR) has been reported as poor. We assessed the survival for prehospital CPR in our trauma system and attempted to find prehospital predictors of mortality. We conducted a retrospective review of our Level I trauma center's database that identified 588 patients over a 6-year period (January 1, 1997, to December 31, 2002) who received prehospital CPR. Mechanisms of injury, prehospital vital signs, and survival to discharge were analyzed. Twenty-two of 588 patients (3.7%) survived to hospital discharge. Overall, 60.7% did not survive to achieve hospital admission, and an additional 32.6% died on the first hospital day. Patients with penetrating injuries had a significantly lower survival rate than those with either blunt or other (eg, drowning, hanging) injuries (0.9% versus 6.2%, and 13.2%, respectively, p < 0.001) and significantly lower Revised Trauma Scores (RTS; mean ± SD: 0.32 ± 0.96 versus 0.76 ± 1.84 and 1.18 ± 2.51, respectively, p < 0.05.) The likelihood of survival with RTS = 0 was less than 1% overall, and 0% for penetrating trauma. These findings add support to recent guidelines regarding the termination or withholding of resuscitation for trauma patients in the prehospital setting. Victims of penetrating trauma with a prehospital RTS = 0 (combination of no respiratory rate, no systolic blood pressure, and a Glasgow Coma Score of 3) should be declared “dead at the scene.”

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