Richard Lyon

Development of a simple algorithm to guide the effective management of traumatic cardiac arrest

BACKGROUND Major trauma is the leading worldwide cause of death in young adults. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has been regularly reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. Current ILCOR guidelines do not contain a standard algorithm for management of traumatic cardiac arrest. We present a simple algorithm to manage the major trauma patient in actual or imminent cardiac arrest. METHODS We reviewed the published English language literature on traumatic cardiac arrest and major trauma management. A treatment algorithm was developed based on this and the experience of treatment of more than a thousand traumatic cardiac arrests by a physician - paramedic pre-hospital trauma service. RESULTS The algorithm addresses the need treat potential reversible causes of traumatic cardiac arrest. This includes immediate resuscitative thoracotomy in cases of penetrating chest trauma, airway management, optimising oxygenation, correction of hypovolaemia and chest decompression to exclude tension pneumothorax. CONCLUSION The requirement to rapidly address a number of potentially reversible pathologies in a short time period lends the management of traumatic cardiac arrest to a simple treatment algorithm. A standardised approach may prevent delay in diagnosis and treatment and improve current poor survival rates.

Tissue oxygen saturation measurement in prehospital trauma patients: a pilot, feasibility study

Background This study evaluated the feasibility of prehospital tissue oxygen saturation (StO2) in major trauma patients. Methods A prospective, pilot feasibility study carried out in a physician based prehospital trauma service. Results Prehospital StO2 was recorded on 13 patients. Continuous StO2 monitoring was achieved on all patients, despite intermittent failure of pulse oximetry and non-invasive blood pressure monitoring in six patients. No adverse outcomes of StO2 monitoring were reported. The specific equipment used was reported to be inconveniently bulky and heavy for use in the prehospital setting. Conclusions Prehospital measurement and monitoring of StO2 is feasible in trauma patients undergoing prehospital anaesthesia and may be useful in the early identification of shock, triggering of transfusion protocols and guiding fluid resuscitation.

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. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has now been reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. There is no standard treatment algorithm for traumatic cardiac arrest. We present a simple algorithm to manage the major trauma patient in actual or near cardiac arrest.