Algorithm for the resuscitation of traumatic cardiac arrest patients in a physician-staffed helicopter emergency medical service

Abstract

Survival rates following traumatic cardiac arrest (TCA) are known to be poor but resuscitation is not universally futile. There are a number of potentially reversible causes to TCA and a well-defined group of survivors. There are distinct differences in the pathophysiology between medical cardiac arrests and TCA. The authors present some of the key differences and evidence related to resuscitation in TCA, and suggest a separate algorithm for the management of out-of-hospital TCA attended by a highly trained physician and paramedic team.

Prehospital traumatic cardiac arrest

“…Patients were predominately cared for by ALS paramedics in large, well-developed EMS systems. Although these EMS systems include a population of almost 24 million people (nearly 10% of the North American population)(40) and span diverse geographic and socioeconomic spectrums, rates of survival or associations between procedures and outcomes may not be applicable to EMS systems with different structures or capabilities (physician-led services(11, 12), for instance).…”

“…Guidelines have been developed to identify patients for whom resuscitation efforts should be withheld or terminated in the field(1) and emergency department settings(8-10). Concurrently, narrative reviews proposing treatment algorithms for traumatic arrest patients have been published that emphasize the early treatment of reversible causes of arrest(11, 12) and selective use of resuscitative thoracotomy(8, 9). …”

Traumatic cardiac arrests - the action or the provider, what makes the difference?

“…However, after review of current literature, Sherren and colleagues developed and published in a recent edition of Critical Care a detailed treatment algorithm for their helicopter emergency medical service (HEMS) that encourages aggressive resuscitation for patients in traumatic cardiac arrest (TCA) [1]. What is known in a review of the quoted literature is that in the prehospital care environment, the survival rate of TCA patients is 0 to 3.7%, but in newer published studies survivability has risen to 7.5% [2,3].…”

Review of therapeutic agents employed by an Australian aeromedical prehospital and retrieval service

“…Adrenaline was given in nine patients with traumatic cardiac arrest (TCA). This is non‐standard in our SOP for the management of TCA as adrenaline is thought to be of no benefit in this setting . However, all cases did otherwise receive standard TCA interventions as per the relevant SOP.…”