Commentary and conceptsDevelopment of a simple algorithm to guide the effective management of traumatic cardiac arrest☆
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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2021, ResuscitationCitation Excerpt :We found that more than half of the EMS-treated patients were hypotensive on arrival at scene, which may indicate hypovolemic shock. Hence, appropriate and rapid management, including volume replacement before chest compressions are likely to be more beneficial in this patient group.5,16,17 Recent human and animal trials found that prehospital transfusion of blood products yielded a significant survival benefit compared to crystalloid alone.30,31
Acting on the potentially reversible causes of traumatic cardiac arrest: Possible but not sufficient
2021, ResuscitationCitation Excerpt :Guidelines promoted implementation of specific measures Contrary to the recommendations of medical aetiology in OHCA that have simplified over time to improve their application, TCA management after prioritising basic, and advanced life support must also take into account potentially reversible causes.7,8 Such management requires clear guidelines which provide detailed instructions on how resuscitation should be performed.9,10
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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.