II. Evaluation: Recognize pre-arrest changes

  1. Agonal respirations or apnea
  2. Weak pulses
  3. Decreasing mental status

III. Management: Key Lifesaving Interventions

  1. See Primary Survey
  2. Airway Obstruction
    1. Early definitive airway (Advanced Airway, Cricothyrotomy)
  3. Tension Pneumothorax
    1. Needle Thoracostomy or finger Thoracostomy (followed by Chest Tube)
  4. Massive Hemothorax
    1. Autotransfusion of blood from Chest Tube
    2. Surgical repair (for >1500 ml blood loss or 200 ml/h for >3 hours)
  5. Open chest wound
    1. Occlusive Dressing and Chest Tube
  6. Cardiac Tamponade
    1. Emergency Pericardiocentesis
    2. Emergency Thoracotomy (Penetrating Trauma)
  7. Massive Hemorrhage
    1. Obtain two large bore (16 to 18 gauge) Intravenous Access sites (or IO Access)
      1. Obtain central venous access as available
    2. Control Bleeding
      1. Apply direct pressure, then Tourniquet, Suture or Topical Hemostatic Agent
    3. Massive Blood Transfusion
      1. May require 4 or more units pRBC within first hour
      2. Replace 1 unit FFP per pRBC unit and 1 unit apheresis platelets per 8 pRBC units
  8. Epidural Hematoma
    1. Trephination (burr hole) if imminent Herniation signs
    2. Emergent surgical decompression

IV. Management: Cessation of efforts

  1. Blunt Trauma
    1. No pulse, pupillary activity, organized EKG activity or cardiac motion on Ultrasound after 10 minutes
  2. Pentrating Trauma
    1. Consider Emergency Thoracotomy if presenting with Asystole and Cardiac Tamponade
    2. No pulse, pupillary activity, organized EKG activity or cardiac motion on Ultrasound after 15 minutes

V. Prognosis: Predictors of Survival

  1. Initial cardiac rhythm
  2. Signs of life on hospital arrival (11.5% survival vs 2.6%)
  3. Pupillary response (highly predictive of survival)
  4. Glasgow Coma Scale (GCS) >3
  5. Cardiac activity on Bedside Ultrasound
    1. Absence of cardiac activity is an indication to cease Resuscitation
  6. Organized cardiac rhythm
    1. Ventricular Fibrillation (90% survival)
    2. Pulseless Electrical Activity (60% survival)
    3. Asystole (low survival rate)
  7. References
    1. Cera (2003) Am Surg 69(2): 140-4 [PubMed]
    2. Leis (2013) J Trauma Acute Care Surg 74(2): 634-8 [PubMed]
    3. Rhee (2000) J Am Coll Surg 190(3): 288-98 [PubMed]

VI. References

  1. Pascual (2015) Crit Dec Emerg Med 29(6): 10-7

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Ontology: Cardiac arrest due to trauma (C1828387)

Concepts Injury or Poisoning (T037)
SnomedCT 422970001
English Cardiac arrest due to trauma (disorder), Cardiac arrest due to trauma
Spanish paro cardíaco por traumatismo, paro cardíaco por traumatismo (trastorno)