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Cpr in trauma
- 1. PATIENT CPR IN THE TRAUM COMBINED ED/TRAUMA CONFERENCE Mohammad F. Shaikh, MD #CPRinTrauma @shaikh_mf @FresnoTrauma
- 2. AGENDA • What is CPR? • Does CPR help in traumatic arrest? • Does CPR hurt in traumatic arrest? • What’s the deal with traumatic arrest? CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 3. CPR • Closed cardiac massage • For medical cardiac arrest • Euvolemia CPR IN TRAUMA WHAT IS CPR? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 4. CPR CPR IN TRAUMA WHAT IS CPR? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 5. ESSENTIAL FOR GOOD CPR • Adequate rate • Adequate depth • Adequate recoil CPR IN TRAUMA WHAT IS CPR? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 6. INADEQUATE CPR CPR IN TRAUMA WHAT IS CPR? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 7. CPR - TAKEAWAYS • Preload is key for effective CPR CPR IN TRAUMA WHAT IS CPR? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 8. CPR - TAKEAWAYS (TRAUMA) • Preload is key for effective CPR • Hemorrhage = decreased preload CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 9. TRAUMA+CPR RESEARCH • Poor outcomes • Difficult to perform RCTs • Animal studies CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 10. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 11. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 12. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 13. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 14. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 15. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 16. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 17. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 18. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 19. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 20. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 21. CPR IN TRAUMA DOES IT HELP? Vitals: BP, HR Lab values: BD, Lactate Echo: EF Path: End Organ Damage #CPRinTrauma @shaikh_mf @FresnoTrauma
- 22. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 23. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 24. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 25. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 26. CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 27. CPR IN TRAUMA DOES IT HELP? Gp 1 CCC Gp2 WB Gp3 NS Gp4 WB + CCC Gp5 NS + CCC #CPRinTrauma @shaikh_mf @FresnoTrauma
- 28. CPR IN TRAUMA DOES IT HELP? Gp 1 CCC Gp2 WB Gp3 NS Gp4 WB + CCC Gp5 NS + CCC #CPRinTrauma @shaikh_mf @FresnoTrauma
- 29. CPR IN TRAUMA DOES IT HELP? Gp 1 CCC Gp2 WB Gp3 NS Gp4 WB + CCC Gp5 NS + CCC #CPRinTrauma @shaikh_mf @FresnoTrauma
- 30. CPR IN TRAUMA DOES IT HELP? Gp 1 CCC Gp2 WB Gp3 NS Gp4 WB + CCC Gp5 NS + CCC #CPRinTrauma @shaikh_mf @FresnoTrauma
- 31. CPR IN TRAUMA DOES IT HELP? Gp 1 CCC Gp2 WB Gp3 NS Gp4 WB + CCC Gp5 NS + CCC #CPRinTrauma @shaikh_mf @FresnoTrauma
- 32. TRAUMA+CPR RESEARCH • Does CPR help in trauma? CPR IN TRAUMA DOES IT HELP? NO #CPRinTrauma @shaikh_mf @FresnoTrauma
- 33. TRAUMA+CPR RESEARCH • No Clear Benefit CPR IN TRAUMA DOES IT HELP? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 34. TRAUMA+CPR RESEARCH • No Clear Benefit • But what about harm? CPR IN TRAUMA DOES IT HURT? ?#CPRinTrauma @shaikh_mf @FresnoTrauma
- 35. CPR DOWNSIDES CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 36. CPR DOWNSIDES CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 37. CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 38. PATHOPHYSIOLOGY CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 39. CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 40. CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 41. MORE CPR DOWNSIDES • Delay necessary procedures • Impair primary and secondary evaluation • Put health care workers at risk • Decrease diastolic pressure CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 42. CPR: HELP OR HURT? CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 43. CPR: HELP OR HURT? CPR IN TRAUMA DOES IT HURT?
- 44. CPR: HELP OR HURT? CPR IN TRAUMA DOES IT HURT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 45. TRAUMATIC ARREST - NOW WHAT? CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 46. TRAUMATIC ARREST - NUANCES CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 47. TRAUMATIC ARREST - NUANCES Shock and arrest in the setting of trauma is hemorrhagic until proven otherwise It is possible to have a medical arrest and then a subsequent trauma Syncopal fall MVC The single greatest predictor of survival is time to hemorrhage control CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 48. TRAUMATIC ARREST - NUANCES CPR has no role in penetrating trauma CPR might have a possible, small, secondary role in blunt trauma in specific settings associated with age, comorbidities and mechanism CPR should be deprioritized in favor of more trauma- specific interventions CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 49. TRAUMATIC ARREST - PRIORITIES Relieve tension pneumothorax Establish airway/ iv access Reverse hypovolemia STOP THE BLEED CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 50. STOPPING THE BLEED Manual Compression Tourniquet Surgery Angiography ED Thoracotomy REBOA CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 51. STOPPING THE BLEED Manual Compression Tourniquet Surgery Angiography ED Thoracotomy REBOA CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 52. REBOA CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 53. STOPPING THE BLEED Manual Compression Tourniquet Surgery Angiography ED Thoracotomy REBOA CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 54. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 55. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 56. ED THORACOTOMY 18 centers 56 patients survived to discharge CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 57. ED THORACOTOMY Blunt trauma, CPR < 10 mins Penetrating trauma, CPR < 15 mins Organized narrow-complex rhythm Tamponade CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 58. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 59. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 60. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 61. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 62. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 63. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 64. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 65. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 66. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 67. ED THORACOTOMY CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 68. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 69. FAST CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 70. ED THORACOTOMY PPV 12.8% | NPV 100% CPR IN TRAUMA SO… NOW WHAT?
- 71. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 72. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 73. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 74. CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 75. TRAUMATIC ARREST - PRIORITIES Relieve tension pneumothorax Establish airway/ iv access Reverse hypovolemia STOP THE BLEED CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 76. TRAUMATIC ARREST - PRIORITIES Relieve tension pneumothorax Establish airway/ iv access Reverse hypovolemia STOP THE BLEED NO ROLE FOR CPR CPR IN TRAUMA SO… NOW WHAT? #CPRinTrauma @shaikh_mf @FresnoTrauma
- 77. CPR IN TRAUMA? What is CPR? Does CPR help in traumatic arrest? Does CPR hurt in traumatic arrest? What’s the deal with traumatic arrest? CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 78. CPR IN TRAUMA? Demonstrated benefit in medical arrest Does CPR help in traumatic arrest? Does CPR hurt in traumatic arrest? What’s the deal with traumatic arrest? CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 79. CPR IN TRAUMA? Demonstrated benefit in medical arrest Old & new research: no benefit in trauma Does CPR hurt in traumatic arrest? What’s the deal with traumatic arrest? CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 80. CPR IN TRAUMA? Demonstrated benefit in medical arrest Old & new research: no benefit in trauma Negative aspects of CPR well-documented What’s the deal with traumatic arrest? CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 81. CPR IN TRAUMA? Demonstrated benefit in medical arrest Old & new research: no benefit in trauma Negative aspects of CPR well-documented Traumatic arrest requires different priorities CPR IN TRAUMA #CPRinTrauma @shaikh_mf @FresnoTrauma
- 82. THANK YOUCOMBINED ED/TRAUMA CONFERENCE Mohammad F. Shaikh, MD #CPRinTrauma @shaikh_mf @FresnoTrauma
Editor's Notes
- The formalised system of chest compression was really an accidental discovery made in 1958 by William Bennett Kouwenhoven, Guy Knickerbocker, and James Jude at Johns Hopkins University.[11] They were studying defibrillation in dogs when they noticed that by forcefully applying the paddles to the chest of the dog, they could achieve a pulse in the femoral artery. Further meticulous experimentation involving dogs answered such basic questions as how fast to press, where to press, and how deep to press. This information gave them the belief that they were ready for human trials. Maryland Medical Society meeting on September 16, 1960 in Ocean City Acosta P et al. Resuscitation great. Kouwenhoven, Jude and Knickerbocker: The introduction of defibrillation and external chest compressions into modern resuscitation. Resuscitation. 2005 Feb;64(2):139-43.
- 3 adult baboons, femoral arterial and femoral vein catheters; thoracotomy pericardial drain placed; first tamponade then hypovolemia and then barbituate overdose
- 6 dogs/ group, . Under anesthesia, dogs were hemorrhaged until pulse was lost; they were maintained pulseless for 30 minutes and then resuscitated over 20 minutes. Vital signs and laboratory values were recorded at determined intervals. Echocardiography was performed throughout the study. Upon termination of the study, kidney, liver, heart, and brain tissue histology was evaluated for end organ damage
- 6 dogs/ group, . Under anesthesia, dogs were hemorrhaged until pulse was lost; they were maintained pulseless for 30 minutes and then resuscitated over 20 minutes. Vital signs and laboratory values were recorded at determined intervals. Echocardiography was performed throughout the study. Upon termination of the study, kidney, liver, heart, and brain tissue histology was evaluated for end organ damage
- 6 dogs/ group, . Under anesthesia, dogs were hemorrhaged until pulse was lost; they were maintained pulseless for 30 minutes and then resuscitated over 20 minutes. Vital signs and laboratory values were recorded at determined intervals. Echocardiography was performed throughout the study. Upon termination of the study, kidney, liver, heart, and brain tissue histology was evaluated for end organ damage
- 6 dogs/ group, . Under anesthesia, dogs were hemorrhaged until pulse was lost; they were maintained pulseless for 30 minutes and then resuscitated over 20 minutes. Vital signs and laboratory values were recorded at determined intervals. Echocardiography was performed throughout the study. Upon termination of the study, kidney, liver, heart, and brain tissue histology was evaluated for end organ damage
- 6 dogs/ group, . Under anesthesia, dogs were hemorrhaged until pulse was lost; they were maintained pulseless for 30 minutes and then resuscitated over 20 minutes. Vital signs and laboratory values were recorded at determined intervals. Echocardiography was performed throughout the study. Upon termination of the study, kidney, liver, heart, and brain tissue histology was evaluated for end organ damage
- 39 white pigs; 7 pigs per group, hemorrhage model;
- 39 white pigs; 7 pigs per group, hemorrhage model;
- 39 white pigs; 7 pigs per group, hemorrhage model;
- 39 white pigs; 7 pigs per group, hemorrhage model;
- 39 white pigs; 7 pigs per group, hemorrhage model;
- 39 white pigs; 7 pigs per group, hemorrhage model;