Traumatic Cardiac Arrest

This section is ONLY an Adult protocol; however, the practitioner may find this protocol's information useful for pediatric patients and consider use of similar treatment with weight appropriate equivalent doses at their discretion.

Traumatic cardiac arrestis most commonly due

• Head trauma with loss of respiratory drive
• Blood loss internally or externally with hypotension
• Structural defect that compromises airway or circulation such as facial trauma, neck trauma, pneumothorax, cardiac tamponade

*Blunt trauma related cardiac arrest is fatal

**Penetrating trauma related cardiac arrest can occasionally be successfully resuscitated

Airway

• Intubation via jaw thrust with spinal immobilization

Breathing

• Assess for tension pneumothorax and decompress immediately if present
• Open pneumothorax should be covered with Vaseline gauze with 3 sides taped down
• Hemothorax or pneumothorax requires chest tube placement

Circulation

• At least 2 large bore IV's
• Stop external hemorrhage and provide IV fluid resuscitation (IV fluids and PRBCs if indicated)
• Chest compressions if no pulse with assessment of rhythm/pulse approximately every 2 minutes
• Assess for shockable rhythm
• Provide IV fluid resuscitation (Crystalloid plus PRBC's if indicated)
• Permissive hypotension is of benefit in penetrating trauma as IV fluids given to improve blood pressure increase blood loss

Disability/Exposure

• The patient should be fully examined to look for any injuries that might explain the traumatic cardiac arrest that might be rapidly correctable

Thoracotomy for Traumatic Arrest?

• Thoracotomy is performed for suspected or definite chest trauma with the intent of opening the chest to resolve a structural defect (typically cardiovascular injury that is resulting in internal blood loss)
• If the patient has no signs of life before thoracotomy; success is negligible
• * Blunt trauma related cardiac arrest thoracotomy <2% survival
• ** Penetrating trauma related cardiac arrest thoracotomy ~ 10% survival

Source: Circulation 2005;112. 2005 AHA Guidelines for CPR and ECC.