What is the treatment for traumatic arrest?

Treatment of Traumatic Cardiac Arrest

The treatment of traumatic cardiac arrest requires immediate identification and correction of reversible causes, with chest compressions, airway management, and rapid transport to a trauma center as the foundation of care.

Initial Assessment and Safety

• Ensure scene safety first - particularly important in trauma scenarios 1
• Quickly determine if the arrest is traumatic in nature
• Assess for signs of life and begin resuscitation if indicated

Algorithm for Traumatic Cardiac Arrest Management

Step 1: Immediate Actions

1. Begin high-quality chest compressions (CAB sequence)
2. Establish airway management
3. Provide oxygen at highest feasible concentration 1
4. Control obvious external hemorrhage
   • Direct pressure for most bleeding
   • Apply tourniquet for severe limb hemorrhage when direct compression is ineffective 1

Step 2: Identify and Treat Reversible Causes

Simultaneously address the most common reversible causes of traumatic arrest:

1. Hypovolemia

   • Establish large-bore IV/IO access
   • Initiate fluid resuscitation
   • Control bleeding sources

2. Tension Pneumothorax

   • Perform needle or finger thoracostomy
   • Consider tube thoracostomy if resources available

3. Cardiac Tamponade

   • Perform pericardiocentesis if trained and equipped
   • Consider resuscitative thoracotomy if indicated 1

4. Hypoxia

   • Ensure proper airway management
   • Address impact brain apnoea in head injuries 1

Step 3: Resuscitative Interventions Based on Mechanism

• Penetrating trauma: Consider resuscitative thoracotomy for cardiac tamponade 1
• Blunt trauma: Focus on addressing hypovolemia and tension pneumothorax

Special Considerations

Thoracotomy

• May be considered in very select circumstances for out-of-hospital cardiac arrest from penetrating trauma with short transport times to a trauma facility 1
• More effective for cardiac tamponade than for other causes 1

Transport Decisions

• Transport to a designated trauma center if ROSC achieved
• Consider early transport even with ongoing CPR in young trauma patients 1
• Avoid moving patients to other parts of venues/facilities for ongoing resuscitation 1

Termination of Resuscitation

• Survival from traumatic cardiac arrest is rare 1
• Consider termination if:
  • Resuscitation has exceeded 30 minutes
  • No signs of life
  • No reversible causes identified

Important Pitfalls to Avoid

1. Delayed identification of reversible causes - Traumatic arrest is different from medical arrest; focus on identifying and treating reversible causes immediately

2. Focusing solely on chest compressions - While important, addressing the underlying cause (bleeding, pneumothorax, tamponade) is critical for survival

3. Inappropriate tourniquet use - Apply only when necessary; reassess frequently and place as distally as possible to control bleeding 1

4. Delayed transport - Definitive care at a trauma center improves outcomes; don't delay transport for prolonged field interventions

5. Failure to consider mechanism - Treatment priorities differ between blunt and penetrating trauma

Traumatic cardiac arrest carries a poor prognosis overall, with survival rates much lower than medical cardiac arrest. However, prompt identification and treatment of reversible causes can lead to successful resuscitation in select cases, particularly when the arrest is witnessed and immediate interventions are available.