There may be differences in blunt or penetration trauma. Nevertheless, reversible causes of cardiac arrest should be solved as soon as possible, following the international guidelines for resuscitation.In the study conducted by Engdahl et al. in G?teborg, significant differences that were also observed with respect to patient age, location of the event, and initial ECG [15]. Trauma-related cardiac arrest happens more often in much younger patients. In the present study, trauma patients were 15 years younger compared with patients with cardiac causes, and the proportion of patients aged over 60 years was 45% compared with 72% younger than 60 years. This difference in age was also found by David et al. [18]. The location of cardiac arrest also differed.

More than 50% of all trauma-related cardiac arrest occurred in public places, suggesting that these patients were physically active until the onset of the cardiac arrest.LimitationsOn the basis of the requirements and definitions given in the Utstein-type protocol, most publications on CPR exclude cardiac arrest patients with non-cardiac causes. This substantially reduces the number for comparable publications.Utstein recommended different end-points for describing the success of resuscitation after cardiac arrest. As the GRR does not focus on outcome following hospital admission, we stopped analysis at the time of hospital admission in the present study, but used data from the TR-DGU database for in-hospital follow up. The addition of further demographic variables, patient-related factors such as pre-existing diseases, and laboratory variables may lead to further improvements in the outcome.

However, these variables were not recorded and therefore could not be included in the analysis.In Germany, the EMS are staffed by physicians from several disciplines (mainly anesthesia, surgery, and internal medicine) who have additional training in emergency medicine. This structure allows more pre-clinical invasive technical interventions and the administration of drugs. It further allows the option of stopping any resuscitation attempts at the scene by declaring the cardiac arrest victim as dead. In this respect, the German system, however, does not allow comparisons with the corresponding results of paramedic-based EMS in terms of therapy or outcome.

Finally, documentation of patients within the TR-DGU was stopped when the patient was discharged from the acute-care hospital. It would be extremely valuable to have further follow-up data of these patients, but this is not allowed currently due to the anonymity of data collection.ConclusionsIn contrast to some trauma management programs [4] suggesting that patients with cardiac arrest caused by severe trauma may not have any chance of survival, our present study Anacetrapib encourages CPR attempts in cardiac arrest patients following trauma.