A few weeks ago we reviewed a paper on the management of traumatic cardiac arrest. That paper specifically looked at the role of closed chest compressions in traumatic cardiac arrest (TCA). I recently managed to catch up with the lead author, an old friend of mine and an expert in the management of this complex condition.
In this podcast we discuss the background to Jason’s research and discuss the recent closed chest compression trial in some detail.
My take home messages were.
- TCA is not a futile condition
- Successful outcomes can be as good as for medical cardiac arrest in some systems
- Not every TCA is due to exsanguination
- If the patient is in asystole we lack evidence of what to do (although the outcomes are terrible in this group anyway)
- in the UK TCA is not that common so we need to train our resus teams to manage this e.g. through Sim sessions
- Closed chest compressions can inhibit other interventions (such as rapid infusion of blood)
There are a lot of myths, dogma and misunderstanding of TCA management. We hope you find the podcast and the linked references helpful1–12.
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- 1.Smith JE, Le Clerc S, Hunt PAF. Challenging the dogma of traumatic cardiac arrest management: a military perspective. Emerg Med J. October 2015:955-960. doi:10.1136/emermed-2015-204684
- 2.Watts S, Smith JE, Gwyther R, Kirkman E. Closed chest compressions reduce survival in an animal model of haemorrhage-induced traumatic cardiac arrest. Resuscitation. July 2019:37-42. doi:10.1016/j.resuscitation.2019.04.048
- 3.Vassallo J, Webster M, Barnard EBG, Lyttle MD, Smith JE. Epidemiology and aetiology of paediatric traumatic cardiac arrest in England and Wales. Arch Dis Child. September 2018:437-443. doi:10.1136/archdischild-2018-314985
- 4.Barnard E, Yates D, Edwards A, Fragoso-Iñiguez M, Jenks T, Smith JE. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales — A retrospective database analysis. Resuscitation. January 2017:90-94. doi:10.1016/j.resuscitation.2016.11.001
- 5.Rickard AC, Vassallo J, Nutbeam T, et al. Paediatric traumatic cardiac arrest: a Delphi study to establish consensus on definition and management. Emerg Med J. April 2018:434-439. doi:10.1136/emermed-2017-207226
- 6.Hillman CM, Rickard A, Rawlins M, Smith J. Paediatric traumatic cardiac arrest: data from the Joint Theatre Trauma Registry. J R Army Med Corps. June 2015:276-279. doi:10.1136/jramc-2015-000464
- 7.Vassallo J, Nutbeam T, Rickard AC, et al. Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation. Emerg Med J. August 2018:emermed-2018-207739. doi:10.1136/emermed-2018-207739
- 8.Barnard E, Yates D, Edwards A, Smith JE. Reply to Letter: Mortality in traumatic cardiac arrest. Resuscitation. April 2017:e23. doi:10.1016/j.resuscitation.2017.01.004
- 9.Barnard EBG, Hunt PAF, Lewis PEH, Smith JE. The outcome of patients in traumatic cardiac arrest presenting to deployed military medical treatment facilities: data from the UK Joint Theatre Trauma Registry. J R Army Med Corps. October 2017:150-154. doi:10.1136/jramc-2017-000818
- 10.Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. J R Soc Med. January 2015:11-16. doi:10.1177/0141076814560837
- 11.Carley S. Should we use closed chest compressions in traumatic cardiac arrest? St Emlyn’s. http://www.stemlynsblog.org/jc-should-we-use-chest-compressions-in-traumatic-cardiac-arrest-st-emlyns/. Published 2019. Accessed 2019.
- 12.May N. Traumatic Cardiac Arrest. St Emlyn’s. http://www.stemlynsblog.org/traumatic-cardiac-arrest/. Published 2012. Accessed 2019.