1/🧵 This #Trauma #MorningPaper is a retrospective study of 284 cases of traumatic cardiac arrest (TCA) in Sweden, mostly men with mean age of 38. Are our attempts always futile? @SMHMajorTrauma @nottsurgeon @ShehanHett @karimbrohi @londonsdrcosmo @e1v1m1
sjtrem.biomedcentral.com/articles/10.11…
sjtrem.biomedcentral.com/articles/10.11…
2/ The study region has no #REBOA or prehospital resus thoracotomy services. 90.1% of TCA were prehospital with 64.8% from blunt injuries. Only 6.7% had shockable rhythm.
29.9% survived to ICU with mean days on ventilator of 3d. Only 10% survived to 30 days (GOS 3 or 4 mostly).
29.9% survived to ICU with mean days on ventilator of 3d. Only 10% survived to 30 days (GOS 3 or 4 mostly).
3/ In-hospital TCA had a much higher chance of survival (42.9% vs 7.0%) - but remember there is no prehospital thoracotomy/aortic compression/REBOA services, therefore I'm not sure how applicable this data is if setup were different. @viseshsankaran @traumakhan @WilsonMSJ 
4/ Cause of death within 24h was mainly due to bleeding (60.2%), whilst mortality after 24h were mainly related to #TBI (not specified as to whether this may actually be hypoxic brain injury). *Prehospital chest compressions did not alter mortality rates*, as expected..
5/ For in-hospital TCA cases, survival was predicted by presence of pupillary response, higher platelets and fibrinogen, higher pH but lower lactate, base deficit and S100b.
Of the 36% who underwent resus thoracotomy, timing was crucial (9.5min for survivors vs 23min).
Of the 36% who underwent resus thoracotomy, timing was crucial (9.5min for survivors vs 23min).
6/ Overall survival (and functional outcome) for #TCA remains poor but possible, especially with improving time to thoracotomy. No differences were seen between #blunt vs #penetrating injuries.
It would be interesting to see data from prehospital interventions.
It would be interesting to see data from prehospital interventions.
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