Traumatic Cardiac Arrest
|Publication: 27/07/2015 --|
|Last review: 15/06/2018|
|Next review: 15/06/2021|
|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.
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.
Traumatic Cardiac Arrest
|Target patient group:||Trauma patients|
|Target professional group(s):||Secondary Care Doctors
- 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.
- 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.
- 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.
- 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.
- Einava S, Kaufman N, Selac HY. Maternal cardiac arrest and perimortem caesarean delivery: Evidence or expert-based? Resuscitation 2012, 83, Issue 10:1191–1200.
- 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.
Trust Clinical Guidelines Group
LHP version 1.0
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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