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HWN Suggests

Chest Compressions in Traumatic Cardiac Arrest

When healthcare practitioners hear the word “arrest” they automatically move into the “chest compressions” mindset. However medical cardiac arrest and traumatic cardiac arrest are two completely different entities with ensuing separate management.

I follow the PERUKI guideline...The bundle needs to be prioritised over chest compressions and defibrillation...

• External haemorrhage control
• Adequate oxygenation and ventilation
• Bilateral thoracostomies
• Rapid volume replacement with blood and blood products (crystalloid only if blood not available)
• Apply pelvic binder in blunt trauma

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Featured

 Should we use chest compressions in traumatic cardiac arrest?

From a pathophysiological perspective the logic of using closed chest compressions in a patient who has no circulating volume is clearly pointless. In order for CCC to work, then the patient has to have an intravascular volume to pump around the circulation. However, that’s just a pathophysiological argument and to date there has been little evidence to support it.

Articles of Interest

GSW to the Chest

If you don’t have a rib spreader, go with the manual technique. You only need three things: chlorhexidine, a scalpel and a pair of hands! I have had the good (or bad) luck to do three thoracotomies on my own and have used this approach. Simply douse the patient in chlorhexidine, cut from the sternum to as far down the lateral side as possible – giving the patient a huge chest “gill”. You then just grab the ribs with your hands and pull the chest open. If you don’t get enough exposure you haven’t given the patient a big enough gill. This method is lightning fast and frees your rather tense mind from worrying about how to orient the rib splitter and other stuff in the thoracotomy tray.

Thoracotomy in non-trauma centre

Penetrating injury to the chest with loss of vital signs for less than 10 minutes is a clear indication for a resuscitative thoracotomy according to the Eastern Association for the Surgery of Trauma

Traumatic Cardiac Arrest

Introduction of ultrasound into the trauma evaluation has advanced management considerably. In the setting of TCA, bedside use of the focused assessment with sonography for trauma (FAST) exam allows for rapid determination of the presence of two potentially reversible causes of PEA arrest: pericardial effusion with cardiac tamponade and hypovolemia due to massive hemoperitoneum.

Traumatic Cardiac Arrest – Can we Find Prognostic Factors that Predict Survival?

Trauma remains the leading cause of death in the United States for those aged less than 45 years old. Those who arrest from hemorrhage or other traumatic mechanism often carry a very poor prognosis. Various studies have placed the survival from blunt traumatic arrest at <10%. Much is dependent however on the systems approach to managing these patients – for example those patients who have very rapid access to surgical resuscitative techniques may have better outcomes.

Traumatic cardiac arrest: what's HOT and what's not

Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting and has a varied aetiology. Paramedic management has changed significantly over the past 5 years. Chest compressions have been de-emphasised in guidelines, and the ‘HOT’ principles have been adopted. This principle stands for hypovolaemia; oxygenation; tension pneumothorax/tamponade. The recommendation is that these should be addressed prior to performing chest compressions.

Resources

Emergency Medicine Cases

A large prospective study out of Los Angeles in 2015 found that no patient with a traumatic cardiac arrest and absence of both cardiac motion and pericardial effusion on POCUS survived ED thoracotomy.

JRSM

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.