Circulation III: traumatic cardiac arrest

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Circulation III: traumatic cardiac arrest

Chart shows algorithm of traumatic cardiac arrest with markings for arrest associated with HX of trauma, check, management along ERC guidelines, PEA/assystole, blunt trauma, et cetera.

Traumatic cardiac arrest – a different disease process to medical cardiac arrest

Until recently, many EMS systems have viewed attempting CPR in traumatic cardiac arrest (TCA) as a futile act given its high mortality. However, more recent research has shown that TCA has similar survival rates to medical cardiac arrest (Lockey et al. 2006).

An arrest associated with significant trauma may lead EMS to believe that it is a primary traumatic arrest. However, it is important to remember that a medical arrest may have precipitated the trauma. This must be considered particularly if the mechanism of injury is of low energy. For instance, a small RTC involving an elderly patient slumped over the steering wheel may have been the result of a myocardial infarction.

Until recently, TCA was considered as following the same disease process as medical cardiac arrest and was managed similarly. However, TCA is an unique disease that occurs as a result of damage to a previously healthy heart. This differs from medical cardiac arrests, the most common cause for which is pre-existing ischaemic coronary artery disease. In TCA, the healthy heart may have arrested as a result of hypoxia, haemorrhage or obstructive shock. If these causes are dealt with promptly, the greater the chance that a previously healthy heart will start functioning again. The commonest causes of medical and TCAs are listed and compared in Table 18.1.