Authors: Bradley MJ et al., J Trauma Acute Care Surg 2016 Nov 81:849
In this prospective observational study, survival was similar for patients undergoing open chest cardiac massage and those receiving only closed chest compressions.
Open chest cardiac massage (OCCM) is an option following emergency department thoracotomy. Previous research has suggested OCCM may improve survival in nontraumatic cardiac arrest patients and enhance organ perfusion in animal models. There are limited data on its effectiveness in traumatic cardiac arrest.
Investigators at a level 1 trauma center performed a prospective observational study of 33 patients with traumatic cardiac arrest who received closed chest compressions only (CCC; 17 patients) or chest compressions converted to OCCM (16 patients). Patients deemed to be dead on arrival or candidates for endovascular aortic balloon occlusion were excluded. Resuscitations were videotaped and reviewed to confirm the timing of conversion to OCCM. End-tidal CO2 was recorded every 6 seconds and was used as a surrogate marker of cardiopulmonary resuscitation quality.
The OCCM group had a higher incidence of penetrating trauma (81% vs. 47%), although gunshot wounds were the most common mechanism of injury in each group. Mean time to conversion to OCCM following initial CCC was 66 seconds. Total resuscitation time was similar in the two groups. In the OCCM group, end-tidal CO2 increased significantly between the initial CCC phase and the OCCM phase. The OCCM and CCC-only groups had similarly low rates of return of spontaneous circulation (24% and 39%) and very high mortality (100% and 88%).
Survival following traumatic cardiac arrest is abysmal no matter what you do. Emergency department thoracotomy has rare specific indications and is not without provider risk. It should never be performed solely for the purpose of performing open cardiac massage.