Traumatic cardiac arrest

Abstract

Purpose of reviewThis review considers the latest evidence relating to the epidemiology and outcomes, treatment guidelines, diagnostic and therapeutic interventions in traumatic cardiac arrest.Recent findingsThere is variation in the incidence and outcomes of traumatic cardiac arrest which is influenced in part by case definitions. Irrespective of case definitions outcomes from traumatic cardiac arrest are typically worse than those seen from cardiac arrest due to medical causes but not so poor as to consider that treatment is futile. Clinical guidelines focus on the prompt treatment of reversible causes, although evidence that this improves outcomes is limited. Point of care ultrasound to assist with the identification of reversible causes should be limited to experienced operators where there is thought to be a high likelihood of a reversible cause being present. Care should be taken to minimize interruptions in chest compressions during scanning. There is little recent evidence to support specific therapeutic interventions. The role of Resuscitative Endovascular Balloon Occlusion of the Aorta during traumatic cardiac arrest remains to be determined in on-going research.ConclusionTrauma related cardiac arrest differs from cardiac arrest due to medical causes. Whilst the core principles of treatment are similar, a higher priority is placed on identifying and treating reversible causes.

Traumatic Cardiac Arrest—A Narrative Review

“…The traditional paradigm of futility of TCA resuscitation has shifted within recent decades towards a more optimistic perspective on TCA outcomes, particularly in selected subgroups of patients. However, reviewing the outcome of TCA is hampered by differences in the included study populations, e.g., including either all TCA patients, or only initially resuscitated TCA patients, or only TCA patients transported to the hospital or the ICU [12].…”

“…Owing to these differences in inclusion criteria, survival to discharge may vastly vary from ~4% to ~40% [12]. One study from the United Kingdom reports an overall 30-day survival of 7.5% in 705 TCA patients, with even a 11.5% survival, when TCA was successfully resuscitated already in the prehospital phase [13].…”

“…Individual prognosis of outcome after TCA is difficult to predict, but certain factors are commonly associated with improved outcome [12]. Beneficial demographic factors include younger age and female sex.…”

“…Regarding mechanism of injury and physiology, improved outcomes are associated with extremity injuries, a lower injury severity score, shockable ECG rhythms, and reactive pupils. Regarding treatment and treatment logistics, improved outcomes are reported for witnessed TCA, bystander CPR, short transport times, and certain interventions, such as airway management [12].…”

“…In addition to (hemorrhagic) hypovolemia, chest compression in obstructive TCA etiologies, e.g., tension pneumothorax and cardiac tamponade, are likely also less effective [12,50]. Considering the economics of resuscitation, resources (e.g., time and personnel) may be allocated to more beneficial, high-yield interventions, instead of performing ineffective or even harmful chest compressions.…”