The Victorian State Trauma System provides support and retrieval services for critically injured patients requiring definitive care, transfer and management. This traumatic cardiac arrest guideline provides evidence-based advice on the management of patients who present to Victorian health services in cardiac arrest or peri-arrest as a result of major trauma. This guideline is developed for all clinical staff involved in the care of trauma patients in Victoria. It is intended for use by frontline clinical staff that provide early care for major trauma patients; those working directly at the Major Trauma Service (MTS) as well as those working outside of a MTS. These management guidelines provide up-to-date information for frontline healthcare clinicians. These guidelines provide the user with accessible resources to effectively and confidently provide early care for critically injured patients in cardiac arrest. The guideline has been assessed utilising the AGREEII methodology for guideline development and is under the auspice of the Victoria State Trauma Committee (VSTC).1
Clinical Emphasis Points:
Pre-arrest: stop the bleeding and restore circulating blood volume (IV / IO / fluid volumes / blood).
Preventable early death in trauma is commonly due to:
Priority should be given to managing the above emergencies before conventional CPR modalities are commenced (external chest compressions / defibrillation).
Penetrating trauma is more likely to respond to resuscitative thoracotomy (RT) than blunt trauma. It is unlikely to be successful if performed more than 10 minutes after the onset of cardiac arrest.
In situations where staff and resources are limited, then a rationalised, adapted systematic approach must be utilised.
Cessation of resuscitation must be actively considered in the patient who is not responding within 10 minutes of correction of reversible causes.
The principles of damage control resuscitation (DCR) form the core of trauma resuscitation in the treatment of uncontrolled haemorrhage.
After resuscitation, retrieval of the patient suffering from a traumatic cardiac arrest (TCA) to a MTS gives the patient the best chance of survival. Primary transfer to a proximate facility may be considered when time-critical immediate surgical intervention is required.
Appropriate access to debriefing after the event for all involved will allow for the sharing of information and processing of the event.