Traumatic arrest in the field - except in the narrowest of circumstances - has universally dismal outcomes. Yet, As the authors of this study observe, a great number of these patients continue to be transported to hospitals.
This is a retrospective review of a prospective trauma registry at Sinai in Chicago in which all traumatic patients with pre-hospital arrest were considered. Patients were excluded for pediatrics, medical causes, drowning/electrocution injuries, and if the prehospital time was less than 15 minutes. Essentially, they were looking at guidelines from the ACS Committee on Trauma for termination of resuscitation in the out of hospital setting - pulseless, apneic, no organized ECG activity, or unresponsive to 15 minutes of resuscitation.
They identified 428 patients in their cohort - and found that 294 of them were transported in violation of guidelines. Of the inappropriately transported patients, 93% were declared dead in the ED and the remaining 6.8% (20 patients) survived the ED. Of those 20, 12 died in surgery, 8 made it to the ICU, and 7 died. A single, neurologically devastated, patient survived to discharge to a long-term care facility with a GCS of 6.
The total hospital charges incurred for the futile resuscitation of these patients totaled $3.8 million - a figure that excludes the EMS charges as well as the long-term care facility charges for the patient with GCS 6.
And this is just a single hospital.
"The Consequences of Noncompliance With Guidelines for Withholding or Terminating Resuscitation in Traumatic Cardiac Arrest Patients"