Prehospital Traumatic Cardiac Arrest

Background-A novel device, the intrathoracic pressure regulator (ITPR), combines an inspiratory impedance threshold device (ITD) with a vacuum source for the generation of controlled Ϫ10 mm Hg vacuum in the trachea during cardiopulmonary resuscitation (CPR) while allowing positive pressure ventilation. Compared with standard (STD) CPR, ITPR-CPR will enhance venous return, systemic arterial pressure, and vital organ perfusion in both porcine models of ventricular fibrillation and hypovolemic cardiac arrest. Methods and Results-In protocol 1, 20 pigs (weight, 30Ϯ0.5 kg) were randomized to STD-CPR or ITPR-CPR. After 8 minutes of untreated ventricular fibrillation, CPR was performed for 6 minutes at 100 compressions per minute and positive pressure ventilation (100% O 2 ) with a compression-to-ventilation ratio of 15:2. In protocol 2, 6 animals were bled 50% of their blood volume. After 4 minutes of untreated ventricular fibrillation, interventions were performed for 2 minutes with STD-CPR and 2 minutes of ITPR-CPR. This sequence was repeated. In protocol 3, 6 animals after 8 minutes of untreated VF were treated with ITPR-CPR for 15 minutes, and arterial and venous blood gases were collected at baseline and minutes 5, 10, and 15 of CPR. A newer, leak-proof ITPR device was used. Aortic, right atrial, endotracheal pressure, intracranial pressure, and end-tidal CO 2 values were measured (mm Hg); common carotid arterial flow also was measured (mL/min). Coronary perfusion pressure (diastolic; aortic minus right atrial pressure) and cerebral perfusion pressure (mean arterial minus mean intracranial pressure) were calculated. Unpaired Student t test and Friedman's repeated-measures ANOVA of ranks were used in protocols 1 and 3. A 2-tailed Wilcoxon signed-rank test was used for analysis in protocol 2. Fischer's exact test was used for survival. Significance was set at PϽ0.05. Vital organ perfusion pressures and end-tidal CO 2 were significantly improved with ITPR-CPR in both protocols. In protocol 1, 1-hour survival was 100% with ITPR-CPR and 10% with STD-CPR (Pϭ0.001). Arterial blood pH was significantly lower and PaCO 2 was significantly higher with ITPR-CPR in protocol 1. Arterial oxygen saturation was 100% throughout the study in both protocols. PaCO 2 and PaO 2 remained stable, but metabolic acidosis progressed, as expected, throughout the 15 minutes of CPR in protocol 3. Conclusions-Compared

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“…Clinical outcomes after both causes of cardiac arrest are traditionally poor if immediate treatment is not available. [11][12][13][14][15][16] …”

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confidence: 99%

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

et al. 2005

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“…10 e ROSEMBURGY et al 19 , que avaliaram especificamente vítimas de trauma, são menos favoráveis aos apresentados por outras publicações 3,4,9,18 , que avaliaram pacientes que apresentaram PCR por diferentes causas.…”

Section: Resultsunclassified

Estudo preliminar das relações entre duração da parada cardiorrespiratória e suas consequências nas vítimas de trauma

Bertelli

Bueno

Sousa

1999

Rev. esc. enferm. USP

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“…Therefore, attempting CPR for patients with BT-CPA has been criticized as a futile and an inappropriate use of valued medical resources. 8,9 Consequently, we sometimes hesitate to implement CPR in BT-CPA patients. However, this could be problematic because we may misdiagnose the causes of CPA.…”

Section: Discussionmentioning

confidence: 99%

Optimal treatment for blunt trauma patients with cardiopulmonary arrest: An account of a successful case and review of the literature

Kondo

Abe

Fukami

et al. 2018

Hong Kong Journal of Emergency Medicine

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Introduction: Prognosis of cardiopulmonary arrest occurring in patients with blunt trauma is very poor; patients rarely recover from this condition. We either do not attempt cardiopulmonary resuscitation or terminate it after some time in blunt trauma-cardiopulmonary arrest cases. We presented a rare case of successful resuscitation of a patient with blunt trauma-cardiopulmonary arrest. Case presentation: A 54-year-old man was admitted to our emergency department after being injured in a traffic accident. The patient suffered from ventricular fibrillation, and spontaneous circulation was restored by a defibrillator. The estimated arrest time was 20 min. Discussion: On arrival of our emergency department, the patient showed intra-abdominal hemorrhage and we performed emergency surgery; 10 days after admission, the patient suffered from pulseless ventricular tachycardiacoronary angiography was performed, which revealed that the patient had coronary artery stenosis. Conclusion:We experienced trauma patients concealed with coronary artery stenosis. In traumatic arrest with ventricular fibrillation, it may be due to a medical reason, and more prolonged and intensive resuscitation may be considered.

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Prehospital Traumatic Cardiac Arrest

Cited by 195 publications

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Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

Intrathoracic Pressure Regulator During Continuous-Chest-Compression Advanced Cardiac Resuscitation Improves Vital Organ Perfusion Pressures in a Porcine Model of Cardiac Arrest

Estudo preliminar das relações entre duração da parada cardiorrespiratória e suas consequências nas vítimas de trauma

Optimal treatment for blunt trauma patients with cardiopulmonary arrest: An account of a successful case and review of the literature

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