Background: Although open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage\nmaneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the\ndescriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness\nof OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED).\nMethods: A nationwide registry-based, retrospective cohort study was conducted. Patients with blunt trauma,\nundergoing cardiopulmonary resuscitation (CPR) in an ED between 2004 and 2015 were identified and divided\ninto OCCPR and CCCPR groups. Their outcomes (survival to hospital discharge and survival over 24 hours\nfollowing ED arrival) were compared with propensity score matching analysis and instrumental variable analysis.\nResults: A total of 6510 patients (OCCPR, 2192; CCCPR, 4318) were analyzed. The in-hospital and 24-hour survival\nrates in OCCPR patients were 1.8% (40/2192) and 5.6% (123/2192), and those in CCCPR patients were 3.6% (156/4318) and\n9.6% (416/4318), respectively. In the propensity score-matched subjects, OCCPR patients (n = 1804) had significantly lower\nodds of survival to hospital discharge (odds ratio (95% CI)) = 0.41 (0.25ââ?¬â??0.68)) and of survival over 24 hours following ED\narrival (OR (95% CI) = 0.59 (0.45ââ?¬â??0.79)) than CCCPR patients (n = 1804). Subgroup analysis revealed that OCCPR was\nassociated with a poorer outcome compared to CCCPR in patients with severe pelvis and lower extremity injury.\nConclusions: In this large cohort, OCCPR was associated with reduced in-hospital and 24-hour survival rates in patients\nwith blunt trauma. Further comparisons between OCCPR and CCCPR using additional information, such as time\ncourse details in pre-hospital and ED settings, anatomical details regarding region of injury, and neurological\noutcomes, are necessary.
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