Management of patients with traumatic cardiac arrest – adapted from the Journal of the American College of Surgery 1995;181:209-14 – Tips from Other Journals
Vigorous attempts at resuscitation are often made in patients presenting with traumatic cardiac arrest and such attempts are often of limited success. Fulton and associates sought to determine the most reasonable approach to the management of traumatic cardiac arrest.
The investigators reviewed the charts of 245 patients who suffered a cardiac arrest either at the scene of the injury, during transport to or in the emergency department or in the operating room. Mechanism of injury, site of cardiac arrest and treatment were noted. Clinical status was evaluated and an estimate of the most probable cause of cardiac arrest was made.
There were six (2.4 percent) survivors and 15 (6.1 percent) potential survivors, defined as patients who had a sustained heart beat following cardiac arrest, only to die while in the hospital. Most cardiac arrests (58 percent) occurred at the scene of injury. Location of the first cardiac arrest did not predict survival. No patient who had more than one cardiac arrest survived. In general, cardiac arrest for longer than 10 minutes was associated with a fatal outcome.
Vehicular trauma was the most common cause of injury (50.6 percent). Most survivors and potential survivors suffered blunt trauma. All six survivors had neurologic function, with a Glasgow coma score of 9 or greater at the scene of injury.
The authors state that the six survivors, four of whom had minimal neurologic damage, justify the use of resources in intense resuscitation efforts. However, the decision to attempt resuscitation should be selective when efforts are likely to be futile. In this study, both primary and secondary brain injury were significant negative factors in successful cardiac resuscitation. All survivors maintained neurologic function throughout treatment. Neither the mechanism of injury nor the age of the patient affected survival in this study group.
Cardiac arrhythmia appeared to be the factor that most influenced outcome. It appeared that no one with asystole or agonal rhythm had a sustained cardiac rhythm after resuscitation. Only patients with easily converted electromechanical dissociation, ventricular fibrillation or tachycardia survived. No patient survived after emergency room thoracotomy, while two survived after undergoing thoracotomy in the operating room.
The authors conclude that patients who have had a cardiac arrest in association with a severe primary brain injury should not be resuscitated. Also, cardiopulmonary resuscitation efforts should be stopped if sustained heartbeat and neurologic function are not restored within 30 minutes. (Fulton RL, et al. Confusion surrounding the treatment of cardiac arrest. J Am Coll Surg 1995;181:209-14.)
COPYRIGHT 1996 American Academy of Family Physicians
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