首页|Approach to traumatic cardiac arrest in the emergency department:a narrative literature review for emergency providers

Approach to traumatic cardiac arrest in the emergency department:a narrative literature review for emergency providers

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  • 国家科技期刊平台
  • NETL
  • NSTL
  • 万方数据
BACKGROUND:Traumatic cardiac arrest(TCA)is a major contributor to mortality and morbidity in all age groups and poses a significant burden on the healthcare system.Although there have been advances in treatment modalities,survival rates for TCA patients remain low.This narrative literature review critically examines the indications and effectiveness of current therapeutic approaches in treating TCA.METHODS:We performed a literature search in the PubMed and Scopus databases for studies published before December 31,2022.The search was refined by combining search terms,examining relevant study references,and restricting publications to the English language.Following the search,943 articles were retrieved,and two independent reviewers conducted a screening process.RESULTS:A review of various studies on pre-and intra-arrest prognostic factors showed that survival rates were higher when patients had an initial shockable rhythm.There were conflicting results regarding other prognostic factors,such as witnessed arrest,bystander cardiopulmonary resuscitation(CPR),and the use of prehospital or in-hospital epinephrine.Emergency thoracotomy was found to result in more favorable outcomes in cases of penetrating trauma than in those with blunt trauma.Resuscitative endovascular balloon occlusion of the aorta(REBOA)provides an advantage to emergency thoracotomy in terms of occupational safety for the operator as an alternative in managing hemorrhagic shock.When implemented in the setting of aortic occlusion,emergency thoracotomy and REBOA resulted in comparable mortality rates.Veno-venous extracorporeal life support(V-V ECLS)and veno-arterial extracorporeal life support(V-A ECLS)are viable options for treating respiratory failure and cardiogenic shock,respectively.In the context of traumatic injuries,V-V ECLS has been associated with higher rates of survival to discharge than V-A ECLS.CONCLUSION:TCA remains a significant challenge for emergency medical services due to its high morbidity and mortality rates.Pre-and intra-arrest prognostic factors can help identify patients who are likely to benefit from aggressive and resource-intensive resuscitation measures.Further research is needed to enhance guidelines for the clinical use of established and emerging therapeutic approaches that can help optimize treatment efficacy and ameliorate survival outcomes.

Traumatic cardiac arrestEmergency thoracotomyResuscitative endovascular balloon occlusion of the aorta

Rashed Alremeithi、Quincy K.Tran、Megan T.Quintana、Soroush Shahamatdar、Ali Pourmand

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Department of Emergency Medicine,George Washington University School of Medicine and Health Sciences,Washington DC 20037,USA

Department of Emergency Medicine,University of Maryland School of Medicine,Baltimore 21201,USA

Program in Trauma,the R Adams Cowley Shock Trauma Center,University of Maryland School of Medicine,Baltimore 21201,USA

Center for Trauma and Critical Care,Department of Surgery,the George Washington University School of Medicine&Health Sciences,Washington DC 20037,USA

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2024

10.5847/wjem.j.1920-8642.2023.085

世界急诊医学杂志(英文)
浙江大学,浙江大学医学院附属第二医院

世界急诊医学杂志(英文)

ISSN：1920-8642
年,卷(期)：2024.15(1)
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