From the Guidelines
CPR is indicated in traumatic cardiac arrest, but it should be performed with a modified approach that addresses the underlying causes of the arrest. The standard CPR protocol should be initiated while simultaneously considering the likely causes of arrest, such as hypoxia, hypovolemia, pneumothorax, or pericardial tamponade, as highlighted in the 2010 American Heart Association guidelines for cardiopulmonary resuscitation and emergency cardiovascular care 1. Key considerations in the management of traumatic cardiac arrest include:
- Controlling hemorrhage
- Securing the airway
- Ensuring adequate ventilation
- Decompressing tension pneumothorax if present
- Addressing cardiac tamponade These reversible causes should be managed concurrently with chest compressions. Fluid resuscitation with balanced crystalloids or blood products is essential for hypovolemic patients, and for tension pneumothorax, needle decompression followed by tube thoracostomy is indicated, as suggested by the principles outlined in 1. The prognosis for traumatic cardiac arrest remains poor, but outcomes can improve when reversible causes are promptly identified and treated alongside CPR, emphasizing the need for a multidisciplinary approach that combines standard resuscitative efforts with trauma-specific interventions.
From the Research
Traumatic Cardiac Arrest and CPR
- Traumatic cardiac arrest (TCA) is a unique problem that poses difficult challenges in the care of trauma patients 2.
- The literature has suggested that attempted resuscitation from TCA in trauma is often futile and consumptive of medical and human resources, but recent studies have demonstrated that the outcome of TCA is comparable to cardiac arrest secondary to non-traumatic events 2.
- Cardiopulmonary resuscitation (CPR) should be initiated in traumatic cardiac arrest, as advanced cardiac life support should be initiated regardless of the initial EKG rhythm 2.
Indications for CPR in Traumatic Cardiac Arrest
- The American Heart Association recommends that CPR be performed in all cases of cardiac arrest, including those caused by trauma 3.
- The latest evidence relating to the epidemiology and outcomes, treatment guidelines, diagnostic and therapeutic interventions in traumatic cardiac arrest suggests that CPR should be initiated in all cases of TCA 4.
- A study published in the European journal of trauma and emergency surgery found that CPR duration/location (out-of-hospital or in-hospital), head injury, and day/night shifts in ED were not associated with outcomes, but prolonged time interval hospital transport and high injury severity score were predictors of failure of CPR 2.
Special Considerations
- Trauma-related cardiac arrest differs from cardiac arrest due to medical causes, and a higher priority is placed on identifying and treating reversible causes 4.
- 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 4.
- Additional emergency medical measures such as pleural decompression, pericardiocentesis, tourniquets, and external stabilization of the pelvis may be necessary in cases of traumatic cardiac arrest 5.