Traumatic Cardiac Arrest

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Authors: Matt Edward, Laura Ashton / Codes: R1 / 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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