Prehospital Traumatic Cardiac Arrest: The Cost of Futility

## Alexander S. Rosemurgy, MD, P. A. Norris, MSN, S. M. Olson, RN, J. M. Hurst, MD, and M. H. Albrink, MD

The Journal of Trauma, Volume 35(3)

#### Description with Key Points:

This study reviewed records for 12,462 trauma patients cared for by prehospital services from October 1, 1989 to March 31, 1991. Out of the total number of patients, 138 underwent CPR at the scene or during transport because of the absence of blood pressure, pulse, and respiration. Ninety-six (70%) suffered blunt trauma, 42 (30%) suffered penetrating trauma. Sixty (43%) were transported by air utilizing county-wide transport protocols. None of the patients survived.

#### Conclusion

Trauma patients who require CPR at the scene or in transport die. Infrequent organ procurement does not seem to justify the cost (primarily borne by hospitals), consumption of resources, and exposure of health care providers to occupational health hazards. The wisdom of transporting trauma victims suffering cardiopulmonary arrest at the scene or during transport must be questioned. Allocation of resources to these patients is not an insular medical issue, but a broad concern for our society, and society should decide if the "cost of futility" is excessive.

Prehospital Traumatic Cardiac Arrest
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# Take Home Message:

138 trauma patients with prehospital cardiac arrest and in whom resuscitation was attempted.
No Survivors
Authors recommended that trauma patients in cardiopulmonary arrest not be transported emergently to a trauma center even in a civilian setting due to large economic cost of treatment without a significant chance for survival.
The Cost of Attempting CPR on the Battlefield: CPR Performers may get killed, Mission Gets Delayed, Casualty stays dead, because CPR done for trauma patients in cardiac arrest DOES NOT WORK!
In combat, futile attempts at CPR may interfere with caring for casualties who have a chance to survive and may interfere with the unit?s ongoing mission.