Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest

Abstract

Closed chest compressions (CCC) are recommended for medical cardiac arrest, but there is little evidence to support their inclusion for traumatic cardiac arrest (TCA). This laboratory study evaluated CCC following haemorrhage-induced TCA and whether resuscitation with blood improved survival compared to saline.The study was conducted with the authority of UK Animals (Scientific Procedures) Act 1986 (received institutional ethical approval and a Home Office Licence) using 39 terminally anesthetised, instrumented, juvenile Large White pigs. Following baseline measurements, animals underwent captive bolt injury to the right thigh and controlled haemorrhage (30% blood volume). Sixty minutes later there was a further haemorrhage to a MAP of 20 mmHg. The randomised resuscitation protocol was initiated within 5 min: CCC (Group 1); IV whole blood (Group 2); IV 0.9% saline (Group 3); IV whole blood + CCC (Group 4); and IV saline + CCC (Group 5). Fluid was administered as 3 Â 10 ml/kg boluses using the Belmont 1 Rapid Infuser. The LUCAS TM II Chest Compression System delivered CCC. Primary Outcome was attainment of return of spontaneous circulation (ROSC MAP ! 50 mmHg) at Study End (fifteen minutes post-resuscitation) and secondary outcomes included haemodynamics.Mortality (MAP 10 mmHg) was significantly higher in Group 1 compared to Groups 2 and 3 (P < 0.0001). Resuscitation with whole blood was significantly better than saline (P = 0.0069), no animals in Group 3 attained ROSC. The addition of chest compressions to fluid resuscitation resulted in a significantly worse outcome with saline resuscitation (P = 0.0023) but not with whole blood (P = 0.4411). Cardiovascular variables at the end of the Resuscitation Phase and Study End were significantly worse for Group 5 compared to Group 3. Some significant differences were present at the end of the Resuscitation Phase for Group 4 versus Group 2 but these differences were no longer present by Study End.CCC were associated with increased mortality and compromised haemodynamics compared to intravenous fluid resuscitation. Whole blood resuscitation was better than saline.

Civilian prehospital transfusion – experiences from a French region

“…Yet it has been reported that the earlier the transfusion is started, the lower the transfusion requirements and the lower the mortality [29,30]. In the cases where cardiac arrest is secondary to exsanguination, only cardiopulmonary resuscitation with PRBC transfusion allowed for a sustainable return of spontaneous circulation [31]. However, a massive transfusion of PRBCs has been shown to worsen metabolic disorders such as hypocalcaemia and thus increase mortality by worsening coagulopathy disorders [32,33].…”

Fluid Therapy During Cardiopulmonary Resuscitation

“…While there is very limited specific evidence to guide management of CPA due to exsanguination, it is reasonable to manage these cases similarly to patients with hemorrhagic shock not in CPA. A recent porcine study in which exsanguination cardiac arrest was induced by peripheral arterial hemorrhage, intra-arrest resuscitation with whole blood compared to 0.9% NaCl was significantly more effective in achieving ROSC (22). In people, a combination of fresh frozen plasma (FFP) and packed red blood cells (PRBC) at a ratio of 1:1 or 1:2 has been suggested, with the addition of cryoprecipitate and platelet concentrate as needed to prevent dilution of fibrinogen and platelets (23).…”

Kreislaufstillstand unter besonderen Umständen

“…Bei einem Kreislaufstillstand aufgrund einer Hypovolämie, Herzbeuteltamponade oder einem Spannungspneumothorax ist es unwahrscheinlich, dass Thoraxkompressionen so effektiv sind wie bei einem normovolämischem Kreislaufstillstand und sie können das verbleibende spontane Herzzeitvolumen verringern [ 46 – 48 ]. Thoraxkompressionen haben daher eine niedrigere Priorität als die Behandlung der reversiblen Ursachen.…”