Lockey et al 2012 - Traumatic Cardiac Arrest algorithm

Question 1

Summarise Lockey et al 2012

Answer 1

Published in Resuscitation

Literature review

Aim to develop an algorithm for management of TCA

Covers:
- Background
- Algorithm and explanation
- Discussion

Take home:
Focus on the easily delivered interventions for reversible pathology
Not always futile

Question 2

Discuss the background to the management of TCA

Answer 2

Historical literature painted a bleak picture - few survivors and those that did with severe neurological impairment

Between 2005 and 2010 futility argument weakened

Identification that those patients that die of haemorrhage are likely unsalvageable as not compressible (vs military where tends to be compressible)

Hypoxia/hypoventilation, TPtx might do better

Suited to an algorithm

Question 3

What is the suggested algorithm for TCA in Lockey et al 2012

Answer 3

1. Confirm arrest
   - Less than 10 seconds
2. Penetrating? If yes do a thoractomy if <10 mins
3. Consider medical cause - if suspected treat as per ALS
4. Commence ALS
5. Simultaneous treatment - HOT
6. ROSC vs termination

Question 4

What does Lockey et al 2012 say about chest compressions?

Answer 4

Should be continued whilst history and mechanism established

If profound hypovolaemia is suspected, prioritise haemorrhage control and volume replacement

Question 5

What does Lockey et al 2012 say about penetrating trauma?

Answer 5

Cardiac tamponade and obstructive shock, or profound hypovolaemia

Need a thoracotomy

<10 minutes

Address a limited number of pathologies - tamponade