Elsevier

Resuscitation

Volume 84, Issue 6, June 2013, Pages 738-742
Resuscitation

Commentary and concepts
Development of a simple algorithm to guide the effective management of traumatic cardiac arrest

https://doi.org/10.1016/j.resuscitation.2012.12.003Get rights and content

Abstract

Background

Major trauma is the leading worldwide cause of death in young adults. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has been regularly reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. Current ILCOR guidelines do not contain a standard algorithm for management of traumatic cardiac arrest. We present a simple algorithm to manage the major trauma patient in actual or imminent cardiac arrest.

Methods

We reviewed the published English language literature on traumatic cardiac arrest and major trauma management. A treatment algorithm was developed based on this and the experience of treatment of more than a thousand traumatic cardiac arrests by a physician – paramedic pre-hospital trauma service.

Results

The algorithm addresses the need treat potential reversible causes of traumatic cardiac arrest. This includes immediate resuscitative thoracotomy in cases of penetrating chest trauma, airway management, optimising oxygenation, correction of hypovolaemia and chest decompression to exclude tension pneumothorax.

Conclusion

The requirement to rapidly address a number of potentially reversible pathologies in a short time period lends the management of traumatic cardiac arrest to a simple treatment algorithm. A standardised approach may prevent delay in diagnosis and treatment and improve current poor survival rates.

Section snippets

Introduction and background

The mortality rate from cardiac arrest associated with trauma is extremely high. All patients with unsurvivable injuries will, by definition, suffer cardiac arrest. For this group only injury prevention measures are likely to improve survival. The published literature before 2005 suggested that the resuscitation of patients who suffer traumatic cardiac arrest (TCA) on scene was at worst futile and at best associated with very poor rates of survival and even worse rates of neurologically intact

Explanation of algorithm

The algorithm aims to rapidly identify and correct reversible causes of TCA. Transport of TCA patients from the pre-hospital to hospital setting with on-going cardiopulmonary resuscitation is usually futile and key interventions need to be performed as soon as possible, usually on-scene. Patients arriving at a hospital in traumatic peri- or cardiac arrest need reversible causes immediately excluded and managed prior to transfer for diagnostic imaging or surgical intervention. The treatment

Discussion

The use of algorithms in emergency medicine and pre-hospital care ensures standardised, rapid delivery of clinical interventions in a structured manner for critically unwell patients. Resuscitation algorithms for medical cardiac arrest are well established and incorporated into regular training for both pre-hospital and hospital personnel. It is important that providers of emergency care appreciate that resuscitation from cardiac arrest is not always futile. Outside specialist centres, EMS

Conclusion

A standard simple approach to traumatic cardiac arrest is feasible and addresses all key reversible pathology that needs to be addressed to maximise the chance of survival. Use of a treatment algorithm can rapidly and simultaneously address reversible causes of traumatic cardiac arrest and has the potential to save lives.

Conflict of interest statement

No conflicts of interest to declare.

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    A Spanish translated version of the abstract of this article appears as Appendix in the final online version at http://dx.doi.org/10.1016/j.resuscitation.2012.12.003.

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