Field Triage of the Pulseless Trauma Patient

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Abstract
CARDIOPULMONARY arrest after trauma is associated with a poor prognosis. Unfortunately, despite our best efforts, modern medicine has not come close to attaining the survival rates depicted in television programs.1 Initial reports on the use of resuscitative thoracotomy in the emergency department (ED) seemed to hold some promise for injured patients with cardiopulmonary arrest (12%-20% survival rate)2-4; however, in spite of advances in medical care, most recent reports indicate that trauma patients requiring cardiopulmonary resuscitation (CPR) have a dismal prognosis (survival rate, 0%-5%).5-11 This abysmal survival rate has led to a less aggressive resuscitative approach and a more restricted use of resuscitative thoracotomy in trauma victims presenting in cardiopulmonary arrest. Many patients are now pronounced dead on arrival shortly after reaching the ED. Eliminating the transport of patients in cardiopulmonary arrest who cannot be resuscitated would reduce the medical teams' exposure to bloodborne diseases, conserve limited resources, and decrease costs to families, trauma centers, and society.