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Traumatic cardiac arrest: what's HOT and what's not

02 May 2018
Volume 10 · Issue 5


Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting and has a varied aetiology. Paramedic management has changed significantly over the past 5 years. Chest compressions have been de-emphasised in guidelines, and the ‘HOT’ principles have been adopted. This principle stands for hypovolaemia; oxygenation; tension pneumothorax/tamponade. The recommendation is that these should be addressed prior to performing chest compressions. There may however be patient groups in TCA who benefit from chest compressions. A management plan including ‘no chest compressions’ for TCA is not supported in the evidence, and they should be commenced as soon as appropriate reversible causes have been addressed. In addition, chest compressions may take precedence over the administration of fluid if both cannot be performed simultaneously. Ambulance services may improve management of TCA by the introduction of an aide-memoire to support clinicians.

Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting, with only 0.3% of 227 994 submissions to Trauma Audit and Research Network (TARN) (Barnard et al, 2017a), estimated at 4 per 100 000 of the population annually (Irfan et al, 2017). Outcome following TCA has been widely debated over many years, and the problem is exacerbated by a wide range of outcome measures being quoted as survival, such as return of spontaneous circulation (ROSC) on scene, ROSC at hospital, and neurological outcome at discharge.

A 2016 review of TARN data by Barnard et al (2017a) reported 30-day survival following pre-hospital TCA as 7.5%. Konesky and Guo (2017) retrospectively analysed outcome in 124 patients who suffered TCA. They found 7.3% survival with complete neurological recovery. As a comparison, Irfan et al (2017) report overall survival as 2.4% in 410 patients who suffered TCA. A systematic review by Zwingmann et al (2012) reported overall survival at 7.2%, with varying degrees of neurological outcome. It is important to note that, in England, the introduction of the Major Trauma Networks has significantly changed the way major trauma patients are managed, and this may have an impact on mortality.

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