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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, December 10, 2015

Parada cardíaca traumática

emDocs - December 10, 2015 - Author: Allen B - Edited by: Koyfman A & Bright J
Traumatic injury is a significant source of morbidity and mortality for all of humankind, and is still the leading cause of death for those ages 1-44 years in industrialized nations. Historically, cardiopulmonary arrest linked to acute traumatic injury has had incredibly poor survival rates, which resulted in resuscitative efforts in the setting of Traumatic Cardiac Arrest (TCA) being deemed futile by many. Recent re-examination of TCA, however, has shown that rates of morbidity and mortality approach that of all-cause cardiac arrest. Depending on populations examined, survival rates have been documented from 0-17%, though Leis et al demonstrated a survival rate of 49.9% with complete neurologic recovery seen in 6.6% of all TCA in one study.4 TCA, unlike medical causes of cardiac arrest, typically stem from a brief list of causes: severe head trauma, hypovolemia, tension pneumothorax, pericardial tamponade, and upper airway obstruction. Given the reversible nature of several potential causes of TCA, intervention by emergency medical providers in a standard, protocol driven fashion could potentially result in continued improvement of survival among this patient population.
In the case of TCA, presenting rhythm is most commonly that of pulseless electrical activity (PEA), followed by asystole/electromechanical dissociation and ventricular dysrhythmias. Theories as to why PEA tends to be the initial cardiac rhythm for TCA focus on the low flow circulatory state as cardiac output falls in the setting of tension physiology, pericardial tamponade, progressive hypoxia or hypovolemia. As such, efforts to resuscitate TCA should be aimed at rapid identification and reversal of the underlying cause..."