Chest compressions during traumatic arrest?

[gro2001]

I was listening to a EmCrit recently where Weingart says chest compressions do nothing for a traumatic arrest. Do you guys actually not do chest compressions during, say, a blunt traumatic arrest? I think everyone realizes that if anything is going to help its going to be other measures (airway, decompressing the chest, volume resus, etc) but to go so far as to not do the compressions at all?

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[Tiger26]

In residency, we'd get yelled at by our trauma surgeons if we continued the EMS chest compressions or gave code dose epi.

For the medics, it's reasonable because they don't have much to offer besides intubation and fluids.

For us, they won't fix the underlying cause.

I agree with Weingart from that podcast. Check the ET tube and vent the chest, along with giving fluids and blood. I'll check with the ultrasound to look for a pericardial effusion, but if there's no evidence of that, then I stop. I'll also look at a FAST

Chest compressions/Epi have no role in blunt cardiac arrest and delay you from performing the above critical actions

 

[Birdstrike]

Ever tried to pump water out of a well without any water in it?

What are your compressions doing, circulating blood volume that is on the pavement, or otherwise not in the patient's heart or blood vessels anymore?

Blunt traumatic arrest, without vital signs on arrival = not much helps, including chest compressions, holy water, and even those new life-prolonging gluten-free, low-carb Kale chips that Dr Oz endorses. If you don't have a quick airway maneuver, needle thoracostomy, or pericardiocentesis that can fix everything right quick, it's Game Over .

Penetrating traumatic arrest = chest compressions don't help either. Open-chest manual heart compressions with your own hands, might help (<1% of the time, or more likely, less) if you have someone else simultaneously patching the hole in the heart, draining the pericardium, clamping the aorta, you've done more than 1 thoracotomy in the past five years, or better yet, if you are a trauma surgeon that does this frequently.

 

[thorg12]

How about traumatic arrest at community hospital? Either blunt or penetrating. Large bore IV access, needle decompress. Anything else? So what if embu fast shows pericardial effusion, are you gonna open the chest with no surgeon in house. Draining the blood with needle isn't gonna fix the hole in the heart.
These are my thoughts on my single coverage overnights.
Or the AAA that ruptures in front of you, then I think I might clamp the aorta.
Thoughts?

 

[dpmd]

How about traumatic arrest at community hospital? Either blunt or penetrating. Large bore IV access, needle decompress. Anything else? So what if embu fast shows pericardial effusion, are you gonna open the chest with no surgeon in house. Draining the blood with needle isn't gonna fix the hole in the heart.
These are my thoughts on my single coverage overnights.
Or the AAA that ruptures in front of you, then I think I might clamp the aorta.
Thoughts?

Opening the chest without a surgeon to then perform the definitive procedure is a foolhardy maneuver. I think it exposes everyone involved to a lot of risk (body fluids all around with sharp objects and a lot of adrenaline equals a pretty high risk situation) without giving much benefit. If you are in a setting where the surgeon and the or team can get there pretty fast it might be worth it, but the community hospitals I am working at now can't get me to starting in the OR any faster than a hour unless I am lucky enough to catch them when they are just finishing a case.

 

[dchristismi]

One of my cardiothoracic surgeons drives a Lamborghini. Unless he was standing IN THE DEPARTMENT WHEN THE PATIENT ARRIVED (ha, yeah right), it's Game Over Dude. Community hospitals, by and large, do not crack chests. I'm sure there are exceptions, but really, unless the surgeon is right there, it's not going to get you anything but a messy heartbreak.

Now, my little non-trauma-center community hospital has done 2 perimortem c-sections in the last 2 years. We joke that we are going to try to become a Center for Excellence. Chest and belly are two very different things...

 

[dpmd]

One of my cardiothoracic surgeons drives a Lamborghini. Unless he was standing IN THE DEPARTMENT WHEN THE PATIENT ARRIVED (ha, yeah right), it's Game Over Dude. Community hospitals, by and large, do not crack chests. I'm sure there are exceptions, but really, unless the surgeon is right there, it's not going to get you anything but a messy heartbreak.

Now, my little non-trauma-center community hospital has done 2 perimortem c-sections in the last 2 years. We joke that we are going to try to become a Center for Excellence. Chest and belly are two very different things...

Also a totally different end game. You don't need anyone to do anything to mom once you open her (well I suppose you might if she isn't dead yet).