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(Circulation. 2005;112:IV-146 – IV-149.)
© 2005 American Heart Association, Inc.

2005 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care

Part 10.7: Cardiac Arrest Associated With Trauma

	Introduction

 
Basic and advanced life support for the trauma patient are fundamentally the same as that for the patient with a primary cardiac arrest, with focus on support of airway, breathing, and circulation. In trauma resuscitation providers perform the Primary Survey (called the initial assessment in the National Highway Traffic Safety Administration [NHTSA] EMS Curricula), with rapid evaluation and stabilization of the airway, breathing, and circulation. This is followed by the Secondary Survey (called the focused history and detailed physical examination in the NHTSA courses), which detects more subtle but potentially lethal injuries.

Cardiopulmonary deterioration associated with trauma has several possible causes:

• Hypoxia secondary to respiratory arrest, airway obstruction, large open pneumothorax, tracheobronchial injury, or thoracoabdominal injury
  
• Injury to vital structures, such as the heart, aorta, or pulmonary arteries
  
• Severe head injury with secondary cardiovascular collapse
  
• Underlying medical problems or other conditions that led to the injury, such as sudden cardiac arrest (eg, ventricular fibrillation [VF]) in the driver of a motor vehicle or in the victim of an electric shock)
  
• Diminished cardiac output or pulseless arrest (pulseless electrical activity [PEA]) from tension pneumothorax or pericardial tamponade
  
• Extreme blood loss leading to hypovolemia and diminished delivery of oxygen
  

Despite a rapid and effective out-of-hospital and trauma center response, patients with out-of-hospital cardiac arrest due to trauma rarely survive.^1–4 Those patients with the best outcome from trauma arrest generally are young, have treatable penetrating injuries, have received early (out-of-hospital) endotracheal intubation, and undergo prompt transport (typically 10 minutes) to a trauma care . . . [Full Text of this Article]