While traditional teaching is that resuscitation on scene in traumatic cardiac arrest is futile, recent studies have demonstrated higher survival rates than previously thought.

The authors (UK emergency medicine and aeromedical specialists) of this paper have reviewed the literature regarding traumatic cardiac arrest and generated an algorithm that is applicable to both pre-hospital and hospital settings.

“The algorithm aims to rapidly identify and correct reversible causes of TCA. Transport of TCA patients from the pre-hospital to hospital setting with on-going cardiopulmonary resuscitation is usually futile and key interventions need to be performed as soon as possible, usually on-scene. Patients arriving at a hospital in traumatic peri- or cardiac arrest need reversible causes immediately excluded and managed prior to transfer for diagnostic imaging or surgical intervention. The treatment priorities in this algorithm have been applied by a physician-led pre-hospital trauma service to over a thousand TCA’s attended over an eighteen year period. Published results demonstrate that adherence to these principles can result in good survival rates from TCA.”

The algorithm focuses on treatment of reversible pathology that may have led to an arrest:

• Correction of hypovolaemia
• Oxygenation
• Decompression of tension pneumothorax
• Thoracotomy in the setting of penetrating chest/epigastric trauma
• Consideration of non-traumatic causes of cardiac arrest

Full text pdf of this paper is available here (secure area limited to ADHB staff only – ADHB has online subscription access to this journal via the Philson Library at the University of Auckland School of Medicine)