Transport of Traumatic Arrest in Asystole
Question# 721
My questions refers to the trauma cardiac arrest protocol, more specifically the trauma TOR. In the latest version of the ALS PCS (5.1), a new contraindication for a Trauma TOR is as stated "patients with penetrating trauma to the torso or head/neck and Lead Trauma Hospital <30 min transport time away". This includes patients who are asystole. I am curious if there is any additional insight/rationale for why these changes were made for the asystole patient (I wasn't able to find anything specific in the ALS PCS supporting documents). Thank you in advance.
Answer:
Thank you for your inquiry. The Medical Directors offer the following comments that were discussed at the Medical Advisory Committee when adding the point to the protocol.
Penetrating trauma to the chest is a special subgroup of trauma patients because they are often young and otherwise healthy and tolerate poor perfusion for longer than expected, and they often have injuries that can be quickly fixed if put in front of the right team. Resuscitative thoracotomy can be performed to fix injuries, relieve cardiac tamponade, and control bleeding, all in the ED. This is the only hope for survival for these patients, and unlike most traumatic cardiac arrests, there is a decent measurable survival rate. Some studies report survival rates in the double digits for properly selected patients at trauma hospitals. Here is a link to one trauma algorithm that is used, and the trauma team in Ottawa abides by it.
westerntrauma.org/wp-content/uploads/2020/08/Resuscitative-Thoracotomy_FINAL.svg
In regards to penetrating trauma to face/airway this might warrant surgical airway which rapid transport is key.
Penetrating trauma causing shock or cardiac arrest with short transport time to a trauma hospital warrants aggressive management of airway, decompress chest, stop external bleeding, and transport rapidly for the only chance at survival.
Penetrating trauma to the chest is a special subgroup of trauma patients because they are often young and otherwise healthy and tolerate poor perfusion for longer than expected, and they often have injuries that can be quickly fixed if put in front of the right team. Resuscitative thoracotomy can be performed to fix injuries, relieve cardiac tamponade, and control bleeding, all in the ED. This is the only hope for survival for these patients, and unlike most traumatic cardiac arrests, there is a decent measurable survival rate. Some studies report survival rates in the double digits for properly selected patients at trauma hospitals. Here is a link to one trauma algorithm that is used, and the trauma team in Ottawa abides by it.
westerntrauma.org/wp-content/uploads/2020/08/Resuscitative-Thoracotomy_FINAL.svg
In regards to penetrating trauma to face/airway this might warrant surgical airway which rapid transport is key.
Penetrating trauma causing shock or cardiac arrest with short transport time to a trauma hospital warrants aggressive management of airway, decompress chest, stop external bleeding, and transport rapidly for the only chance at survival.
References
Published
18 July 2023
ALSPCS Version
5.1
Views
292
Please reference the MOST RECENT ALS PCS for updates and changes to these directives.