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Management of Traumatic Cardiac Arrest

Question #27

For trauma arrest, should we be continuing to analyze/shock after the first analyze if we are transporting as long as it does not delay transport to the hospital? Or is it only one defibrillation for the entire arrest? Also, are PCPAIVs allowed to give a fluid bolus or only ACPs?

Answer:

For traumatic cardiac arrest patients should recieve one rhythm interpretation only. 

The limited use of defibrillation in traumatic cardiac arrest is primarily due to the nature of the cardiac rhythms typically present in such cases. Emphasis is placed on addressing reversible causes through interventions like hemorrhage control, decompression of tension pneumothorax, and relief of cardiac tamponade, and volume replacement, rather than defibrillation, which is reserved for specific shockable rhythms. If you believe you are dealing with a special circumstance and feel additional defibrillations would benefit the patient, you may patch to the base hospital physician for direction. That being said, the primary focus should be on reversal or reversible causes. 

As for fluid, yes PCPs with AIV may admister fluid to a traumatic cardiac arrest. However, volume replacement with normal saline should not be prioritized over transport or managmenet of other reversible causes. There is no evidence to suggest that saline will increase end-outcomes for these patients. 

 

References

Hébert, S., Kohtakangas, E., Campbell, A., & Ohle, R. (2023). The efficacy of prehospital IV fluid management in severely injured adult trauma patients: A systematic review and meta-analysis. Canadian Journal of Emergency Medicine, 25(2), 200–208. https://doi.org/10.1007/s43678-023-00447-9

Morrison, C. A., Carrick, M. M., Norman, M. A., Scott, B. G., Welsh, F. J., Tsai, P., Liscum, K. R., Wall, M. J., & Mattox, K. L. (2011). Hypotensive resuscitation strategy reduces transfusion requirements and severe postoperative coagulopathy in trauma patients with hemorrhagic shock: Preliminary results of a randomized controlled trial. Journal of Trauma, 70(3), 652–663. https://doi.org/10.1097/TA.0b013e31820e77ea

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Medical Directive Category

Trauma Cardiac Arrest

Published

12 February 2025

ALSPCS Version

5.4

Views

46

Please reference the MOST RECENT ALS PCS for updates and changes to these directives.