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Vasopressors in prehospital traumatic arrest

ΓΕΩΡΓΙΟΥ ΓΕΩΡΓΙΟΣ geokgeo at otenet.gr
Thu Dec 2 23:08:58 GMT 2010

I had quite recently two patients ages 5 and 6 years with blunt trauma and 
traumatic arrest while on transit to the hospital .No prehospital 
resuscitation.At the ED the  CPR succeeded to restore heart function and 
peripheral pulses but didn’t revive the cerebrum in both cases.Finally 
expired after 240 and 70 minutes respectively. In both cases cause of death 
according to autopsy reports was severe head injury.
Looking at the literature I noticed and read with scepticism a paper 
published in  Am.J.Surg.148:20 , on a long 1984 by Copass M.K.et al, 
''Prehospital Cardiopulmonary Rescusitation of the Critically Injured 
Patient'',denoting survival of 30 patients out of 131 after succesfull CPR 
,of whom 29 were discharged and 25 return to their everyday activities !.The 
summary of the paper was :''Prehospital cardiopulmonary resuscitation 
combined with endotrachial intubation ,vigorous fluid resuscitation,and 
rapid transport can be effective in rescuscitating trauma patients in 
cardiopulmonary arrest...''
It seems that this message is hardly accepted today.

George C.Georgiou
Xanthi General Hospital

----- Original Message ----- 
From: "caesar ursic" <cmursic at gmail.com>
To: "Trauma-List [TRAUMA.ORG]" <trauma-list at trauma.org>
Sent: Thursday, December 02, 2010 6:18 AM
Subject: Re: Vasopressors in prehospital traumatic arrest

> My own admittedly anecdotal observations over the years have been that
> patients pretty much dead at the scene (either asystolic or with an 
> terminal
> 'escape' rhythm on ECG strip) are temporarily 'revived' by medics with 
> doses
> of epinephrine and atropine (producing some sort of cardiac rhythm with no
> real cardiac output) that gets them to the ER just in time for the 
> assembled
> team to be 'compelled' into 'doing something' because - "look, the heart's
> beating!"  Unfortunately despite chest tubes, more epinephrine, the
> occasional anterolateral thoracotomy, closed chest compressions, etc - the
> cardiac rhythm deteriorates and no BP is ever obtained.  So I think that 
> in
> the vast majority of patients just have their death pronouncements delayed
> and many get unnecessary procedures performed.  of course the occasional
> 'medical' arrest presumed to be traumatic might benefit from prehospital
> ACL-like drugs, but that's a rare exception.
> I have no data with which to back this opinion up.  Just observation.
> On Wed, Dec 1, 2010 at 1:58 PM, Kmattox <kmattox at aol.com> wrote:
>> Futility.   When God puts her or his hand take yours off.   Recognize
>> death.  Dead people tend to remain dead.   Do not make the ultimate
>> pronouncement more painful and expensive.
>> k
>> Sent from my iPhone
>> On 2010-12-01, at 4:00 PM, caesar ursic <cmursic at gmail.com> wrote:
>> > What, if any, is the role of epinephrine or atropine (the "typical" 
>> > ACLS
>> > cardiac arrest drugs) in prehospital traumatic arrest?
>> > Do you approach the 35 year old who has had 15 mins of prehospital CPR
>> after
>> > falling off a third story balcony (because he was found "pulseless and
>> > bradycardic" at the scene) once he arrives in your ER any differently 
>> > if
>> he
>> > has / has not received multiple doses of epi and atropine (assuming 
>> > that
>> the
>> > patient is still pulseless but has some sort of ECG rhythm on arrival)?
>> > Just curious.
>> >
>> > CM Ursic, MD
>> > Honolulu
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