The Australian Resuscitation Council (ARC) has published a traumatic cardiac arrest (TCA) algorithm in order to prioritise life saving measures and treat reversible causes prior to commencement of chest compressions2. The most common cause of traumatic cardiac arrest death is from haemorrhage3. External blood loss is usually obvious yet occult bleeding can be challenging for the provider to recognise and manage in its early stages. Time to resuscitation is critical and relies on many factors all working together including advanced prehospital care and onward movement to a specialised trauma centre for definitive care. The diagnosis of TCA is made clinically, with the patient presenting with coma, agonal or absent spontaneous respiration and the absence of a carotid pulse. The patient in peri-arrest will be hypotensive, and have a deteriorating conscious state. Progression to full cardiac arrest will be imminent unless resuscitative efforts are commenced immediately.
Resuscitation should be withheld in TCA in the following circumstances:
No signs of life within the preceding 15 minutes.
Massive trauma incompatible with survival (e.g. decapitation, incineration). The termination of resuscitation should be considered if there is:
No ROSC after reversible causes have been addressed.
No detectable cardiac activity on ultrasound.
Where cardiac arrest of a non-traumatic origin has led to a secondary traumatic event (i.e. the patient had a cardiac arrest while driving and drove into a tree), this should be recognised early and treated with standard ALS algorithms. In these cases, shockable rhythms are more common (VF/VT). If the history, mechanism of injury and injuries displayed are inconsistent with TCA, then treat the patient using standard Advanced Life Support principles.