Outcomes of trauma victims with cardiac arrest who survive to intensive care unit admission.

Background: The prognosis for patients with return of spontaneous circulation after trauma-related cardiac arrest (TRCA) is unclear. Our purpose was to (1) determine outcomes for patients with TRCA resuscitated and admitted to the intensive care unit (ICU), (2) identify ICU-based predictors of in-hospital death in this population, and (3) compare outcomes of patients resuscitated from TRCA and atraumatic cardiac arrest (ATCA).

Methods: We performed a cohort study using a registry of ICU admissions from 120 US hospitals from 2001 to 2005. Inclusion criteria were age >17 years, admission to ICU via the emergency department, and cardiopulmonary resuscitation preceding ICU arrival. The primary outcome measure was survival to hospital discharge. We compared TRCA and ATCA using binomial test and performed multivariable logistic regression to determine independent predictors of death among trauma subjects.

Results: A total of 4,048 subjects were included (309 TRCA and 3,739 nonTRCA). Forty percent of trauma subjects survived. Independent predictors of death among trauma subjects included persistent postresuscitation cardiovascular failure in the ICU and presentation to a nontrauma center. Despite being younger and having fewer comorbidities, subjects with TRCA had lower survival than subjects with ATCA (40% vs. 49%, p = 0.003).

Conclusions: Despite lower survival than ATCAs, a significant percentage of TRCAs surviving to ICU admission were discharged alive. This suggests aggressive support of this population is not necessarily futile. Investigation into whether optimization of postresuscitation factors would improve outcome for these patients may be warranted.