Traumatic cardiac arrest

Abstract

Traumatic cardiac arrest is known to have a poor outcome, and some authors have stated that attempted resuscitation from traumatic cardiac arrest is futile. However, advances in damage control resuscitation and understanding of the differences in pathophysiology of traumatic cardiac arrest compared to medical cardiac arrest have led to unexpected survivors. Recently published data have suggested that outcome from traumatic cardiac arrest is no worse than that for medical causes of cardiac arrest, and in some groups may be better. This review highlights key areas of difference between traumatic cardiac arrest and medical cardiac arrest, and outlines a strategy for the management of patients in traumatic cardiac arrest. Standard Advanced Life Support algorithms should not be used for patients in traumatic cardiac arrest.

Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management

“…This is in keeping with the current guidance from ILCOR (International Liaison Committee on Resuscitation) 18. In some circumstances, paediatric TCA may represent a very low output state and not a true cardiac arrest, especially when it has a reversible cause 19. This fundamental concept is why paediatric TCA should be approached differently to that of a medical cardiac arrest.…”

Military application of mechanical CPR devices: a pressing requirement?

“…Many of the studies on mCPR devices exclude traumatic cardiac arrest,41 which in the military setting is the largest group overall. Advances in damage control resuscitation and an understanding of the differences in pathophysiology between traumatic and non-traumatic cardiac arrest has led to improvements in outcome 42. From a military perspective, this has led to a survivability of 24% 43.…”

“…From a military perspective, this has led to a survivability of 24% 43. The common cardiac rhythm following traumatic cardiac arrest is pulseless electrical activity often reflecting a low output state 42. The most common reversible cause for this is hypovolaemia secondary to blood loss.…”

“…The role of CPR is therefore less clearly understood. In animal models, improvements in BP with chest compressions in normovolaemic cardiac arrest were not reproduced in hypovolaemic arrest 42. Moreover, undertaking CPR in a traumatic cardiac arrest may interfere with more pressing life-saving measures such as thoracostomies, venous access and the rapid infusion of blood and blood products.…”

Military Anaesthesia in contingencies: what skill sets are required and how will we prepare our trainees?

“…Cardiothoracic anaesthesia: A joint workshop with the trauma surgeons who review the current management of cardiothoracic injuries32 including the management of traumatic cardiac arrest 33. A cadaveric workshop allows rehearsal of where personnel stand and key moments during procedures, particular a thoracotomy.…”