Traumatic cardiac arrest

Background

  • Classically thought to invariably lead to death
  • However, recent data suggests that survival from traumatic cardiac arrest is similar to that of medical causes of cardiac arrest[1]
    • One military study demonstrated 24% survival of patients who underwent resuscitation after traumatic arrest[2]

Clinical Features

  • Initial rhythm usually PEA

Differential Diagnosis

Evaluation

  • Pre-operation labs
  • Base excess, ABG/VBG, lactate
  • Type and cross
  • CXR
  • Pelvic XR
  • eFAST

Management

General approach per ATLS guidelines

  • Large bore PIV or central line access with blood products, massive transfusion
  • Establishing resuscitation airway
  • Bilateral thoracostomy, can do finger thoracostomies instead of tube or needle.[3]
  • Emergency thoracotomy
    • If thoracotomy not indicated then pericardiocentesis or cardiac ultrasound to evaluate for tamponade.
  • Consider REBOA catherization and balloon inflation
  • Long bone fracture reduction, if there is suspicion of significant enough hemorrhage
  • Pelvic binding
  • Surgical stabilization
  • Standard ACLS and BLS may delay critical interventions
    • No definitive animal or human evidence to support external chest compressions in traumatic cardiac arrest[4]
    • No evidence to support IV epinephrine in traumatic arrest, with the exception of neurogenic shock

Disposition

  • Emergency surgery

See Also

External Links

References

  1. Traumatic cardiac arrest: who are the survivors? Lockey D, Crewdson K, Davies G. Ann Emerg Med. 2006 Sep; 48(3):240-4.
  2. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Russell RJ, Hodgetts TJ, McLeod J, Starkey K, Mahoney P, Harrison K, Bell E Philos Trans R Soc Lond B Biol Sci. 2011 Jan 27; 366(1562):171-91.
  3. Scott Weingart. Podcast 62 – Needle vs. Knife II: Needle Thoracostomy?. EMCrit Blog. Published on December 11, 2011. Accessed on December 14th 2019. Available at [ https://emcrit.org/emcrit/needle-finger-thoracostomy/ ].
  4. Smith JE et al. Traumatic cardiac arrest. J R Soc Med. 2015 Jan; 108(1): 11–16.