title: Development of a simple algorithm to guide the effective management of traumatic cardiac arrest.
abstract: BACKGROUND
  Major trauma is the leading worldwide cause of death in young adults. The mortality from traumatic cardiac arrest remains high but survival with good neurological outcome from cardiopulmonary arrest following major trauma has been regularly reported. Rapid, effective intervention is required to address potential reversible causes of traumatic cardiac arrest if the victim is to survive. Current ILCOR guidelines do not contain a standard algorithm for management of traumatic cardiac arrest. We present a simple algorithm to manage the major trauma patient in actual or imminent cardiac arrest.
  
  
  METHODS
  We reviewed the published English language literature on traumatic cardiac arrest and major trauma management. A treatment algorithm was developed based on this and the experience of treatment of more than a thousand traumatic cardiac arrests by a physician - paramedic pre-hospital trauma service.
  
  
  RESULTS
  The algorithm addresses the need treat potential reversible causes of traumatic cardiac arrest. This includes immediate resuscitative thoracotomy in cases of penetrating chest trauma, airway management, optimising oxygenation, correction of hypovolaemia and chest decompression to exclude tension pneumothorax.
  
  
  CONCLUSIONS
  The requirement to rapidly address a number of potentially reversible pathologies in a short time period lends the management of traumatic cardiac arrest to a simple treatment algorithm. A standardised approach may prevent delay in diagnosis and treatment and improve current poor survival rates.
authors.affiliation: Pre-hospital Care, London's Air Ambulance, Royal London Hospital, London E1 1BB & School of Clinical Sciences, University of Bristol, United Kingdom. David.Lockey@nbt.nhs.uk
authors.forename: David J
authors.initials: DJ
authors.lastname: Lockey
authors.forename: Richard M
authors.initials: RM
authors.lastname: Lyon
authors.forename: Gareth E
authors.initials: GE
authors.lastname: Davies
mesh_terms: D000465:Algorithms; D006323:Heart Arrest / Q000209:etiology / Q000401:mortality / Q000628:therapy*; D006801:Humans; D012151:Resuscitation / Q000379:methods*; D013997:Time Factors; D014947:Wounds and Injuries / Q000150:complications* / Q000628:therapy