A simple algorithm for the treatment of traumatic cardiac arrest

Background

Major trauma is the leading causing of death in young adults across the globe. Themortality from traumatic cardiac arrest remains high but survival with good neurologicaloutcome from cardiopulmonary arrest following major trauma has now been reported. Rapid,effective intervention is required to address potential reversible causes of traumaticcardiac arrest if the victim is to survive. There is no standard treatment algorithm fortraumatic cardiac arrest. We present a simple algorithm to manage the major traumapatient in actual or near cardiac arrest.

Methods

We reviewed current pre-hospital clinical practice and the published literature on majortrauma management. An algorithm was developed and used regularly by London’s AirAmbulance pre-hospital physician/paramedic trauma team.

Results

The algorithm addresses the need treat potential reversible causes of traumatic cardiacarrest. This includes immediate resuscitative thoracotomy in cases of penetrating chestor abdominal trauma resulting in cardiac arrest, airway management, optimisingoxygenation, reversal of hypovolaemia using intravenous/intraosseous fluid replacementand chest decompression to exclude tension pneumothorax.

Conclusion

A standard approach to traumatic cardiac arrest is feasible. Use of a treatmentalgorithm can rapidly, simultaneously address reversible causes of traumatic cardiacarrest and has the potential to save lives.