Annotation for Point B
On arrival to the hospital, the time from initiation of CPR is determined directly from prehospital personnel. Only 1% to 2% of blunt trauma patients undergoing RT survive, regardless of clinical status on presentation. Blunt trauma patients with greater than 10 minutes of prehospital CPR and no signs of life (detectable blood pressure, respiratory or motor effort, cardiac electrical activity, or pupillary activity) are pronounced dead.5,10 Penetrating torso trauma patients with greater than 15 minutes of prehospital CPR and no signs of life are pronounced.5,7,10 Following these injuries, 14% of patients requiring RT are salvaged if they are hypotensive with detectable vital signs, whereas 8% of those who have no vital signs but have signs of life at presentation and 1% of those without signs of life are salvaged.5,6 RT with aortic cross-clamping is a potential adjunct in the acute resuscitation of patients with neck or extremity vascular injuries, with an overall survival rate of 11%.11 Those patients with penetrating trauma to the neck or extremity causing massive blood loss and arrest, with greater than 5 minutes of prehospital CPR and no signs of life, are pronounced. Patients within the time guidelines listed or those with signs of life trigger ongoing resuscitation and RT.