Outcomes of open cardiopulmonary resuscitation in pulseless blunt chest trauma: A nationwide cohort study

Introduction: Open cardiopulmonary resuscitation (OCPR) is a critical treatment for severe torso trauma. While OCPR has shown survival benefits for patients with penetrating traumatic cardiac arrest, its efficacy in blunt trauma patients remains unclear. Materials and Methods: This retrospective cohort study analyzed pulseless blunt chest trauma patients from the National Trauma Data Bank (NTDB) in the United States during 2014–2015. The study excluded patients under 18 years of age, those without initial signs of life, and those with burns, penetrating trauma, unknown mechanisms, incomplete records, severe head injuries, or transportation times over 60 min. The primary outcome was Emergency Department (ED) survival, and the secondary outcome was overall survival. Results: Out of 1358 pulseless blunt chest trauma patients, 420 met the inclusion criteria, and 15.5 % (65/420) received OCPR. ED survival was significantly greater in the OCPR group (81.5 % [53/65] vs. 46.8 % [166/355], p < 0.001), whereas overall survival was not significantly different between the groups (9.2 % [6/65] vs. 12.4 % [44/355], p = 0.626). A subset analysis of patients with cardiac injuries showed better ED survival (81.3 % [13/16] vs. 40.5 % [17/42], p = 0.012) and a trend of better overall survival (25.0 % [4/16] vs. 3.4 % [2/42], p = 0.086) for those who underwent OCPR. Conclusion: OCPR does not improve overall survival in all pulseless blunt chest trauma patients, but it offers significant benefits for those with cardiac injuries. Further research is needed to refine management strategies for these patients.