Episode 28: LOST

LOST

 

Cardiac arrest is the end point, it is the symptom, not the diagnosis. The pathophysiological process varies, and this is particularly relevant in trauma vs medical. In medical cardiac arrest, the pathological processes tend to affect the heart’s ability to pump: eg primary cardiac event, chemical/electrolyte abnormality, but full circulation. In trauma the process is generally not primarily due to pump failure, but due to hypovolaemia or obstruction. It might be better to consider traumatic cardiac arrest as a completely different disease eg LOST: Low Output State due to Trauma

The 2015 European Resuscitation Council and UK Resuscitation Council Algorithms for Traumatic Cardiac Arrest:

 

To read the whole ERC guideline on special circumstances cardiac arrest including trauma, click here.

Ultrasound during TCA: Cureton et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. J Trauma. 2012; 73: 102-10.

The outcomes from different resuscitative interventions in a haemorrhagic shock model in porcine model:

Screen Shot 2018-04-16 at 21.01.33

From: Watts et al. Closed chest compressions reduce survival in a model of haemorrhagic-induced traumatic cardiac arrest . EMJ 2017; 34: 860-900. (A866)

Impact brain apnoea: Wilson et al. Impact brain apnoea – A forgotten cause of cardiovascular collapse in trauma. Resuscitation. 2016; 105: 52-58.

References

  1. Barnard et al. Epidemiology and aetiology of TCA in England… Resuscitation; 110 (2017): 90-94.
  2. Russell RJ et al. The role of trauma scoring in developing trauma clinical governance in the Defence Medical Services. Phil Trans R Soc. 2011; 366. Doi: 1098/rstb.2010.0232
  3. Wise et al. Emergency thoracotomy ‘how to do it’. EMJ; 2005: 22-24.
  4. Morrison et al. Resuscitative thoracotomy following wartime injury.
  5. Jeffcoach DR et al. Use of CPR in hemorrhagic shock, a dog model.
  6. Lockey et al. Traumatic cardiac arrest: who are the survivors? Annals of Emergency Medicine; 2006.
  7. Grasner et al. Cardiopulmonary resuscitation in traumatic cardiac arrest – there are survivors. Critical Care; 2011.
  8. Zwingmann et al. Survival and neurological outcome after OOH TCA in pediatric & adult populations: a systematic review. Critical Care; 2012.
  9. Slessor et al. To Be Blunt: are we wasting our time? Emergency Deaprtment Thoracotomy following blunt trauma: a systematic review & meta-analysis. Anneals of EM; 2015: 297-307.
  10. Leis CC et sl. TCA: should advanced life support be initiated? J Trauma. 2013; 74: 634-8.
  11. Jacobs et al. Effect of adrenaline on survival in out of hospital cardiac arrest: randomised double-blind placebo controlled trial. Resuscitation. 2011; 82: 1138-43.
  12. Smith et al. Traumatic Cardiac Arrest. Journal of Royal Society of Medicine. 2015; 108: 11-16.
  13. Sperry et al. Early use of vasopressors after injury: caution before constriction. J Trauma. 2008; 64: 9-14/

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