Resuscitation in traumatic cardiac arrest has been a topic of debate regarding its effectiveness and outcomes. While some studies suggest that attempted resuscitation from traumatic cardiac arrest may be futile (Smith et al., 2015; Abdou et al., 2021), others indicate that survival with good neurological outcomes is possible (Seewald et al., 2022; Gräsner et al., 2011). Incorporating resuscitative thoracotomies and open chest compressions in algorithms for non-traumatic cardiac arrest has been proposed as a way to potentially improve outcomes (Kornhall & Dolven, 2014). Additionally, the use of extracorporeal cardiopulmonary resuscitation (ECPR) has shown promise in improving neurologic outcomes after out-of-hospital cardiac arrest of cardiac origin (Maekawa et al., 2013).
Studies have highlighted the importance of addressing reversible causes in traumatic cardiac arrest, such as hypoxia, hypovolemia, and mechanical obstruction through appropriate interventions like definitive airway management, fluid resuscitation, simple thoracostomy, pericardiocentesis, etc.. (Watts et al., 2019). Furthermore, the identification of modifiable risk factors for cardiac arrest may help in improving resuscitation outcomes (Wen et al., 2015). Time is a critical factor in traumatic cardiac arrest, where the duration of out-of-hospital resuscitation predicts survival and influences the selection of appropriate resuscitative procedures (Kelly & Clare, 2020).
While some authors argue that resuscitation efforts after traumatic cardiac arrest may be futile, others suggest, with significant evidence, that there is a possibility of survival with good neurological outcomes. The use of advanced techniques such as addressing reversible causes like hypoxia, hypovolemia, and mechanical obstructions are crucial in improving outcomes in traumatic cardiac arrest scenarios. Additionally, timely interventions and the identification of modifiable risk factors play a significant role in enhancing resuscitation outcomes in such cases.
References:
- Abdou, H., Madurska, M., Edwards, J., Patel, N., Richmond, M., Galvagno, S., … & Morrison, J. (2021). A technique for open chest selective aortic arch perfusion. Journal of Trauma and Acute Care Surgery, 90(6), e158-e162.
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- Gräsner, J., Wnent, J., Seewald, S., Meybohm, P., Fischer, M., Paffrath, T., … & Lefering, R. (2011). Cardiopulmonary resuscitation traumatic cardiac arrest - there are survivors. an analysis of two national emergency registries. Critical Care, 15(6), R276.
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- Kelly, G. and Clare, D. (2020). Improving out‐of‐hospital notification in traumatic cardiac arrests with novel usage of smartphone application. Journal of the American College of Emergency Physicians Open, 1(4), 618-623.
https://doi.org/10.1002/emp2.12146
- Kornhall, D. and Dolven, T. (2014). Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest. World Journal of Emergency Surgery, 9(1).
https://doi.org/10.1186/1749-7922-9-54
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https://doi.org/10.1097/ccm.0b013e31827ca4c8
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https://doi.org/10.1186/s12873-022-00714-5
- Smith, J., Rickard, A., & Wise, D. (2015). Traumatic cardiac arrest. Journal of the Royal Society of Medicine, 108(1), 11-16.
https://doi.org/10.1177/0141076814560837
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https://doi.org/10.1016/j.resuscitation.2019.04.048
- Wen, T., Huang, H., Liang, Y., Huang, X., Xu, L., & Zhang, L. (2015). Impact of system factors and modifiable icu interventions on the outcome of cardio-pulmonary resuscitation in picu. Indian Pediatrics, 52(6), 485-488.
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