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Review
. 2024 Sep 26;4(1):66.
doi: 10.1186/s44158-024-00197-9.

Contemporary management of traumatic cardiac arrest and peri-arrest states: a narrative review

Luca Carenzo  1 , Giulio Calgaro  2 , Marius Rehn  3   4   5 , Zane Perkins  6   7 , Zaffer A Qasim  8 , Lorenzo Gamberini  9 , Ewoud Ter Avest  7   10
Affiliations
Review

Contemporary management of traumatic cardiac arrest and peri-arrest states: a narrative review

Luca Carenzo et al. J Anesth Analg Crit Care. .

Abstract

Trauma is a leading cause of death and disability worldwide across all age groups, with traumatic cardiac arrest (TCA) presenting a significant economic and societal burden due to the loss of productive life years. Despite TCA's high mortality rate, recent evidence indicates that survival with good and moderate neurological recovery is possible. Successful resuscitation in TCA depends on the immediate and simultaneous treatment of reversible causes according to pre-established algorithms. The HOTT protocol, addressing hypovolaemia, oxygenation (hypoxia), tension pneumothorax, and cardiac tamponade, forms the foundation of TCA management. Advanced interventions, such as resuscitative thoracotomy and resuscitative endovascular balloon occlusion of the aorta (REBOA), further enhance treatment. Contemporary approaches also consider metabolic factors (e.g. hyperkalaemia, calcium imbalances) and hemostatic resuscitation. This narrative review explores the advanced management of TCA and peri-arrest states, discussing the epidemiology and pathophysiology of peri-arrest and TCA. It integrates classic TCA management strategies with the latest evidence and practical applications.

Keywords: Cardiac tamponade; Clamshell; Exsanguinating; Hypovolaemia; Hypoxia; REBOA; Tension pneumothorax; Thoracotomy; Trauma; Traumatic cardiac arrest.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Fig. 1
Fig. 1
Proposed mnemonic for the pragmatic approach to a traumatic cardiac arrest
Fig. 2
Fig. 2
Resuscitative thoracotomy. A Front view of clamshell incision and pericardial opening with inverted “T” incision. B Axial view of the chest with operator’s hand performing manual aortic occlusion
Fig. 3
Fig. 3
Resuscitative endovascular balloon of the aorta (REBOA)
See this image and copyright information in PMC

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