LAUSR

Traumatic Cardiac Arrest (TCA) is a potentially fatal consequence of penetrating or blunt trauma. Emergency-Department Resuscitative Thoracotomy (ED-RT) is the last resort procedure to restore cardiac output following TCA. This study reviews current UK guidelines of Major Trauma Centres (MTCs) to identify common indications for ED-RT and chest compressions following TCA. Departmental policies were requested from all UK MTCs. Data was extracted by three reviewers. A planned subgroup analysis was performed for blunt/penetrating trauma. 20 guidelines were identified covering 22 MTCs. All guidelines included recommendations regarding indications for ED-RT. Time thresholds from loss of output to undertaking RT in blunt trauma were given in 12 (60%) guidelines. Ranging from 5 (25%), 10 (50%) and 15 minutes (10%). Prehospital loss of output was a contraindication for blunt trauma ED-RT in 6 guidelines. ED-RT in penetrating trauma was indicated within 10 (50%) or 15 minutes (45%) from loss of output. Fewer than 50% of guidelines identified specific contra-indications including massive head injury and asystole. 3 guidelines stated chest compressions were not indicated in TCA. 8 stated that chest compressions may not be contra-indicated and 1 advised chest compressions to be restricted to blunt trauma. In a survey of UK guidelines, we have found inconsistency in the indications for ED-RT, particularly associated with blunt trauma. A maximum time from loss of output to ED-RT for penetrating trauma of 15 minutes is compatible with most guidelines. This is less consistent with findings for blunt trauma. There is little consensus regarding use of chest compressions.