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Traumatic Cardiac Arrest

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The content you’re about to read or listen to is at least two years old, which means evidence and guidelines may have changed since it was originally published. This content item won’t be edited but there will be a newer version published if warranted. Check the new publications and curriculum map for updates

Authors: Matt Edward, Laura Ashton / Codes: CMP2, CMP3, HMP2, HMP3 / Published: 19/08/2015

Traumatic Cardiac arrest is a stressful and time critical presentation to the ED. You need to have a solid structure in your mind for how to deal with it in a safe and effective manner.

This podcast runs through the management of traumatic cardiac arrest and should help with some of that preparation.

Take a look at the London and Sydney HEMS algorithms and leave some feedback at the bottom of the page, enjoy!

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References:

Epidemiology

  1. Lockey D, Crewdson K, & Davies G. (2006). Traumatic cardiac arrest – who are the survivors? Annals of Emergency Medicine, 48, 240-244. (survival 7.5% (NOT 7.8% as said in the podcast. Apologies and thanks to Dr Crewdson for pointing that out)
  2. Rosemurgy et al. (1993). Prehospital traumatic cardiac arrest: the cost of futility. The Journal of Trauma and Acute Care Surgery, 35(3). (survival O%)
  3. Shimazu S., Shatney C. (1983). Outcomes of trauma patients with no vital signs on hospital admission. The Journal of Trauma and Acute Care Surgery, 23(3). (survival 2.6%)
  4. Fulton R.L., Voigt W.J., & Hilakos A.S. (1995). Confusion surrounding the treatment of traumatic cardiac arrest. Journal of the American College of Surgeons, 181(3), 209-214. (survival 2.4%)
  5. Pasquale et al. (1996). Defining Dead on Arrival: Impact on a Level I trauma center. Journal of Trauma and Acute Care Surgery, 41(4), 726-730. (survival 2.8%)
  6. Stratton S., Brickett K., Crammer T. (1998). Prehospital pulseless, unconscious penetrating trauma victims: field assessments associated with survival. Journal of Trauma and Acute Care Surgery, 45(1), 96-100. (Survivors 9%)
  7. Battistella et al. (1999). Field triage of the pulseless trauma patient. The Archives of Surgery, 134(7), 742-745. ( Survivors 2.6%)
  8. Pickens et al (2005). Trauma patients receiving CPR: predictors of survival. Journal of Trauma, 58, 951-958. (survival 7.6%)
  9. Huber-Wagner S et al: Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation 2007, 75(2) 276-285 (survivors 17.2%)
  10. Stockinger Z.T., McSwain N.E. (2004). Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field. Journal of the American College of Surgeons, 198(2), 227-231. (survivors 3.7%)

The Algorithms

  1. Bhangu A, Lee C, and Porter K: Emergencies in Trauma, Oxford University Press, Print Publication Date: Jan 2010
  2. Lockey et al. (2013). Development of a simple algorithm to guide the effective management of traumatic cardiac arrest. Resuscitation, 84(6), 738-742. Retrieved from http://dx.doi.org/10.1016/j.resuscitation.2012.12.003
  3. Sherren et al. (2013). Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed helicopter emergency medical service. Critical Care, 17(308). Retrieved from http://ccforum.com/content/pdf/cc12504.pdf

Tension Pneumothorax

  1. Waydhas C. & Sauerland S. (2007). Pre-hospital pleural decompression and chest tube placement after blunt trauma: A systematic review. Resuscitation, 72, 11-25.
  2. Martin et al. (2012). Does needle thoracostomy provide adequate and effective decompression of tension pneumothorax? Journal of Trauma and Acute Care Surgery, 73, 1412-1417.

Chest Compressions

  1. Harris T et al, Traumatic Cardiac Arrest: a unique approach. European Journal of Emergency Medicine 2015; 22(2) 72-78
  2. Soar et al. (2010). European resuscitation council guidelines for Resuscitation 2010. Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation, 81, 1400-1433. Retrieved from http://resuscitation- guidelines.articleinmotion.com/article/S0300-9572(10)00441-7/aim/8i-traumatic- cardiorespiratory-arrest
  3. Luna GK et al: Heamodynamic effects of external cardiac massage in trauma shock. J Trauma 1989, 29:1430-1433 (the baboon study!)

Adrenaline

  1. Schadt J.C., Ludbrook J. (1991). Hemodynamic and neurohumoral responses to acute hypovolaemia in conscious mammals. American Journal of Physiology, 260, H305-318.
  2. Grmec S et al: A treatment protocol including vasopressin and hydroxyethyl starch solution is associated with increase rate of return of spontaneous circulation in blunt trauma patients with pulseless electrical activity. Int J Emerg Med 2008: 1:311-316
  3. Pickens et al (2005). Trauma patients receiving CPR: predictors of survival. Journal of Trauma, 58, 951-958. (survival 7.6%)

Ultrasound

  1. Cureton et al. (2012). The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. Journal of Trauma and Acute Care Surgery, 73, 102-110.

End-tidal CO2

  1. Eckstein M et al: End-tidal CO2 as a predictor of survival in out-of-hospital-cardiac arrest. Prehosp Disaster Med 2011, 2683:81-818

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