Traumatic Cardiac Arrest

Publication: 27/07/2015  --
Last review: 15/06/2018  
Next review: 15/06/2021  
Clinical Guideline
CURRENT 
ID: 4276 
Approved By: Trust Clinical Guidelines Group 
Copyright© Leeds Teaching Hospitals NHS Trust 2018  

 

This Clinical Guideline is intended for use by healthcare professionals within Leeds unless otherwise stated.
For healthcare professionals in other trusts, please ensure that you consult relevant local and national guidance.

Traumatic Cardiac Arrest Guideline

  • This guideline is for traumatic cardiac arrest only. If the primary cause of arrest is non-traumatic continue with ALS protocols. It does not cover the techniques of resuscitative thoracotomy.
  • Thoracotomy has four uses:  1/ tamponade relief  2/ aortic compression 3/ internal cardiac massage 4/ thoracic bleed haemostasis.
    • Occlude cardiac wounds with a finger or a foley catheter initially (insert through wound, inflate balloon, gentle traction).
    • Consider lung twist for lung haemorrhage in preference to clamping the hilum.
    • Pack smaller vessel bleeding.
  • External chest compressions in traumatic cardiac arrest have limited effect due to reduced venous return by increased intrathoracic pressure in hypovolaemia. If CPR must be done, do so cautiously and do not delay thoracotomy.(2,7)
  • Adrenaline (epinephrine)/vasopressors have limited use in traumatic arrest when the cause of the arrest is due to hypoxia, hypovolaemia or massive brain injury. There is also evidence that adrenaline in out of hospital cardiac arrest has a limited role.(3,4)
  • Recognise that, despite our best efforts, resuscitative thoracotomy is often futile. If the patient arrests in transit to hospital a decision will need to be made on whether or not to proceed with resuscitation. For blunt trauma attempts at resuscitation more than 5-10 minutes after arrest will almost certainly be futile. For penetrating trauma the window of opportunity is a little longer.

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Provenance

Record: 4276
Objective:
Clinical condition:

Traumatic Cardiac Arrest

Target patient group: Trauma patients
Target professional group(s): Secondary Care Doctors
Adapted from:

Evidence base

  1. Slessor D, Hunter S: To Be Blunt: Are We Wasting Our Time? Emergency Department Thoracotomy Following Blunt Trauma: A Systematic Review and Meta-Analysis. Annals of Emergency Medicine 2015, 65, Issue 3: 297–307.
  2. Luna GK, Pavlin EG, Kirkman T, Copass MK, Rice CL: Hemodynamic effects of External Cardiac Massage in Trauma Shock. J Trauma 1989, 29: 1430-1433.
  3. Jacobsa IG,  Finn JC, Jelinek GA, Oxer HF, Thompson PL: Effect of adrenaline on survival in out-of-hospital cardiac arrest: A randomised double-blind placebo-controlled trial. Resuscitation 2011, 82:1138-1143.
  4. Jeejeebhoy FM, Zelop CM, Windrim R, Carvalho JCA, Dorian P, Morrison LJ. Management of cardiac arrest in pregnancy: A systematic review. Resuscitation 2011, 82 :801–809.
  5. Einava S, Kaufman N, Selac HY. Maternal cardiac arrest and perimortem caesarean delivery: Evidence or expert-based? Resuscitation 2012, 83, Issue 10:1191–1200.
  6. Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: Electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation 2010, 81(10):1400-1433.

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Approved By

Trust Clinical Guidelines Group

Document history

LHP version 1.0

Related information

ETT - endotracheal tube
LMA - laryngeal mask airway
G&S - group and save
ASAP - as soon as possible
CT - computed tomography
US - ultrasound
USS - ultrasound scan
VF - ventricular fibrillation
TXA - tranexamic  acid
CPR - cardiopulmonary resuscitation
ALS - advanced life support

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Equity and Diversity

The Leeds Teaching Hospitals NHS Trust is committed to ensuring that the way that we provide services and the way we recruit and treat staff reflects individual needs, promotes equality and does not discriminate unfairly against any particular individual or group.