traumatic arrest algorithms

[Micah Shaw]

All

First, props for "oded private", your post "transfer to neurosurgical center" sparked a lot of interesting debate.

As a "paraprofessional" in one of the most traumatic theaters, military medicine, I can't speak for civilians, but I can speak for myself and my colleagues.  I, and those that I work with, understand that prehospital CPR in traumatic arrest is worthless in the best case, and as you have mentioned, possibly harmful in the sense of saving the patient.  

The only case that I can see CPR in traumatic arrest as accepted is for morale purposes.  In a combat situation, Marines, Soldiers, and Sailors need to know that their medical coverage is doing all that they can.  The "grunts" (with few exceptions) don't understand what a thoracotomy is, let alone how CPR can hinder.  In a situation where your men and women need to know you are doing all you can for them, and bullets, not chest compressions delay definitive treatment, a minute or two (keeping your own safety in mind) of CPR can tell the Marines "doc is doing all he can for you, fight on".

God forbid anyone in this mailing list has to be exposed to such a situation, but, sad as it is, they arise.

I have learned a lot from this mailing list, hats off to all of you.

Very Respectfully,

HM3 Shaw


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Hi

A few months ago we discussed the role of CPR for pre hospital 
traumatic arrest, and I believe it was broadly agreed that we don't 
know of any evidence showing any positive affect for CPR in traumatic 
arrest. On the other hand, there is good physiolgic sense that it is 
not only futile but might have a theoritical risk of lowering the 
salvage rate of ED thoracotomy due to prolongation of transfer and 
further exshanguintaion with compressions.
Still, it seems to me that many EMS systems do practice close chest 
CPR for traumatic arrest. I see it here in Israel and I also see it 
in documentary TV from the US.
Surgeons- how is it done in your province? What algorithm is the best 
to your opinion?
Same goes for mandatory ET intubation in the field for all traumatic 
arrest victims or victims in extremis (profound shock) vs. 
bag-valve-mask ventilation.
By the way, even the book "trauma" offers an algorithm that mandates 
ET intubation in the field and chest compressions en route to the ED 
for all traumatic arrest victims who still have an EKG rhythm, given 
transfer time does not exceed 10 min.