Date:
04 May 2024
Page URL:
https://ntk.eastamb.nhs.uk/news/cardiac-arrest-month-what-do-you-know-about-traumatic-arrests.htm?pr=
So what do you know about traumatic cardiac arrest (TCA)?
It’s vitally important to recognise the differences in approach to medical cardiac arrest management. Resuscitation Council (UK) 2015 guidelines now acknowledge TCA as a special circumstance and the evidence obtained by the council recognises that, whilst it’s uncommon, there are reported survival rates of six to seven per cent..
Emphasis in TCA is placed upon recognising and treating the pertinent reversible causes otherwise known as airway obstruction, hypoxaemia/ hypoventilation and tension pneumothorax. A TCA is confirmed by the presence of agonal breathing or apnoea and the absence of central pulses in the context of a traumatic insult, injury or incident. Confirming TCA should, like medical arrests, be rapid and normally take less than 10 seconds.
It is important to ensure the critical care desk (CCD) or EOC is aware that you have a patient in TCA so that assistance can be sought in the form of critical care. Resuscitation must be started for all patients in TCA (unless the patient has conditions unequivocally associated with death) – after all, prior to the traumatic insult they were alive and well. This may involve ‘snatch rescue’ from their current position e.g. maybe they’re inside a vehicle or down a ditch. Once the arrest is confirmed, and if staffing levels allow, initiate CPR and if a medical cause is unlikely i.e. a true traumatic cardiac arrest, efforts should be made to rapidly treat the reversible causes (the four Hs and four Ts) as a matter of priority.
It is important to recognise that some reversible causes are more prevalent when associated with the TCA patient:
Managing a TCA needs quick decisive action with at times complex decision making. Remember what help is available to you – either CCD or the Clinical Advice Line (CAL). Patients who have been aggressively resuscitated for TCA and who have had reversible causes addressed and considered can have resuscitation stopped at the scene.
A caution though - for penetrating trauma to the thorax/abdomen, patients should be transported rapidly to hospital (in the event of an enhanced care team not being on scene). This is due to the fact that one of the main reversible causes cannot be addressed (cardiac tamponade). Again, CAL or CCD can provide support and guidance.
So the nitty gritty:
Ash Richardson, Area Clinical Lead
Have any questions on traumatic arrest? Contact our area clinical leads, or Trauma Lead Chris Martin.
Want to practice your cardiac arrest management skills? There are still places left for our ‘cardiac arrest bootcamp’ on 30th November at Newmarket training centre. Open to clinicians of all levels, the bootcamp will include interactive lectures, workshops and real-life scenarios. More details available here on Need to Know.
Published 10th November, 2016