Traumatic Arrest stop CPR?

[Ace 227]

Had a traumatic arrest about 2 hours ago. Blunt trauma from an MVA. CPR started, pt was tubed and IO'd and had one round of epi. When he was still asystole we stopped.

 

[bigbaldguy]

all trauma arrests are arguably a crapshoot.

All arrests are a crap shoot its like Vegas there are only enough winners to give the illusion it's worth playing the game.

 

[bigbaldguy]

That is somewhat of a misleading number.

When you break it down into penetrating arrest, the local variance is between 6-8% usually.

The blunt arrest is <1%

to call it an overall 3% I think is an oversimplification of a more complex statistic that does not reflect reality.

That's what I said and everybody threw stuff at me

I still think its ridiculous that we'll work an 80 year old in cardiac arrest from an MI but not an 18 year old in cardiac arrest from a GSW. Yes there's maybe a 5 percent greater chance of saving the 80 year old but we all know it's probably not going to end well. I still think its primarily a money issue.

 

[Clare]

I wouldn't commence resuscitation on this patient nor would I expect anybody to.

 

[AUSEMT]

All arrests are a crap shoot its like Vegas there are only enough winners to give the illusion it's worth playing the game.

agreed,
this guy had one chance and one chance only:
an ER doc (scott weingart) was walking past and did an open clamshell thoracotomy there and then as well as a surgical airway... even then his chances suck...

CPR is useless in traumatic arrest,
compressing a chest with shredded vessels/ shredded heart/ tamponade/heamopneumothorax is kicking a corpse...<_<

on the bright side, the 0.1% of times you do get ROSC is extremely rewarding

 

[Farmer2DO]

I still think its ridiculous that we'll work an 80 year old in cardiac arrest from an MI but not an 18 year old in cardiac arrest from a GSW. Yes there's maybe a 5 percent greater chance of saving the 80 year old but we all know it's probably not going to end well. I still think its primarily a money issue.

I don't think it's ridiculous at all. CPR and ACLS are designed to work on patients that have a presumed cardiac (medical) etiology for their arrest, not for trauma. Unless you can get the patient to someone that can open their chest within 5 minutes of arrest (and that's a stretch) all you're doing is wasting time, money, and effort, and beating on a corpse. Pumping on the chest and pushing epi isn't going to do squat for a hole in the guy's ventricle. IMHO, either work them all the way or don't do it at all. Doing a few rounds of ACLS on a trauma patient and then calling them is just crappy medicine, again, IMHO.

 

[Veneficus]

I don't think it's ridiculous at all. CPR and ACLS are designed to work on patients that have a presumed cardiac (medical) etiology for their arrest, not for trauma. Unless you can get the patient to someone that can open their chest within 5 minutes of arrest (and that's a stretch) all you're doing is wasting time, money, and effort, and beating on a corpse. Pumping on the chest and pushing epi isn't going to do squat for a hole in the guy's ventricle. IMHO, either work them all the way or don't do it at all. Doing a few rounds of ACLS on a trauma patient and then calling them is just crappy medicine, again, IMHO.

I agree.

I would add only that if you do not have the ability to actually use some sort of surgical intervention to restore delivery of o2, it is pointless to even begin resuscitation.

 

[Clare]

I still think its ridiculous that we'll work an 80 year old in cardiac arrest from an MI but not an 18 year old in cardiac arrest from a GSW. Yes there's maybe a 5 percent greater chance of saving the 80 year old but we all know it's probably not going to end well. I still think its primarily a money issue.

The aetiology of the two are very different. A primary cardiac arrest from an underlying problem such as infarction or dysrhythmia has a much better prognosis than somebody who has had a cardiac arrest because their heart has no blood in it as it's all leaked out of a big hole from being stabbed or shot.

Unless you can treat a reversible cause of traumatic arrest (usually hypovolaemia or pneumothorax) fast then there is really no point in continuing resuscitation beyond a few (say 5-10) minutes; there is generally no blood in the heart so CPR is not really going to help.

There may be a role for quickly transporting to hospital where somebody capable of opening the chest is standing in ED if there is an immediately identified and fixable problem such as haemopericardium or something but other than that I have no problems with quickly working then ceasing or flat out not working somebody who is in cardiac arrest because of trauma.