From the Guidelines
Chest compressions are crucial in traumatic injury patients who develop cardiac arrest and should be performed promptly according to standard CPR protocols with a rate of 100-120 compressions per minute and a depth of 2-2.4 inches, as recommended by the 2020 American Heart Association guidelines 1. When performing chest compressions in traumatic injury, it's essential to simultaneously address the potential underlying causes of arrest, particularly hypovolemia from blood loss, tension pneumothorax, cardiac tamponade, and hypoxia.
- Key considerations include:
- Rapid control of hemorrhage
- Needle decompression for suspected tension pneumothorax
- Pericardiocentesis if cardiac tamponade is suspected
- Fluid resuscitation with blood products, typically starting with 2 units of packed red blood cells and following a 1:1:1 ratio of blood:plasma:platelets for massive transfusion The importance of chest compressions in traumatic injury is highlighted by the fact that they are the most critical component of CPR, as stated in the 2020 American Heart Association guidelines 1. Unlike medical cardiac arrests, trauma arrests have poorer outcomes, but immediate chest compressions combined with rapid treatment of reversible causes offers the best chance of survival, as the physiological basis for this approach is that trauma patients often arrest due to specific, potentially reversible conditions rather than primary cardiac pathology, so addressing these causes while maintaining circulation through compressions is critical for successful resuscitation. The 2010 American Heart Association guidelines also emphasize the importance of high-quality CPR, including providing chest compressions of adequate rate and depth, allowing complete chest recoil after each compression, minimizing interruptions in compressions, and avoiding excessive ventilation 1.
From the Research
Role of Chest Compressions in Traumatic Injury
- Chest compressions play a crucial role in generating blood flow to the heart and brain in cardiac arrest patients, including those with traumatic injuries 2
- However, in traumatic cardiac arrest, chest compressions are inferior and should not delay treatment of reversible causes such as massive bleeding, hypoxia, tension pneumothorax, and pericardial tamponade 3
- The primary focus in traumatic cardiac arrest should be on treating reversible causes, with chest compressions being secondary to these interventions 3
Technique and Quality of Chest Compressions
- Optimal technique for adult chest compressions includes positioning the patient supine, pushing hard and fast over the center of the chest, and minimizing interruptions 2
- The rate of chest compressions should be at least 100 compressions per minute, with a depth of at least 5 cm 2, 4
- Aggressive rotation of compressors can help prevent decline in chest compression quality due to fatigue 2
Chest Decompression in Traumatic Cardiac Arrest
- Chest decompression, including thoracostomy or needle decompression, can be an effective treatment for tension pneumothorax and bilateral pneumothorax in traumatic cardiac arrest 5
- Chest decompression can help identify and treat potentially life-ending injuries, and should be considered as part of the resuscitation effort in traumatic cardiac arrest 5