Field Triage of the Pulseless Trauma Patient

Battistella, Felix D.; Nugent, Wendy; Owings, John T.; Anderson, John T.

doi:10.1001/archsurg.134.7.742

Cited by 117 publications

(66 citation statements)

References 12 publications

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“…In this study and in a few other published studies, performance in checking the carotid pulse was so poor that the value of including a check of the carotid pulse in BCLS remains debatable. [1][2][3][5][6][7][8] These results question the routine use of the carotid pulse check as a step of BCLS during CPR, including for health care providers.…”

Section: Discussionmentioning

confidence: 99%

“…4 Checking the pulse is commonly performed all over the world by health care providers, but, in contrast, the effectiveness of this act is poorly documented with only a few published studies. [1][2][3][5][6][7][8] Several studies suggested that the accuracy of performance in checking the carotid pulse is poor and could delay the onset of CPR. [1][2][3] Furthermore, in most published studies, it is not established whether health care providers' performance in checking the pulse is increased compared with lay rescuers.…”

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confidence: 99%

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Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

Lapostolle

Toumelin

Agostinucci

et al. 2004

Academic Emergency Medicine

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The American Heart Association recently abolished the carotid pulse check during cardiopulmonary resuscitation for lay rescuers, but not for health care providers. Objectives: The aim of the study was to evaluate health care providers' performance, degree of conviction, and influencing factors in checking the carotid pulse. Methods: Sixtyfour health care providers were asked to check the carotid pulse for 10 or 30 seconds on a computerized mannequin simulating three levels of pulse strength (normal, weak, and absent). Health care providers were asked whether they felt a pulse and how certain were they that they felt a pulse. Performance was evaluated, as well as degree of conviction about the answer, using a visual analog scale. Data were compared by using a general linear model procedure. Results: In the pulseless situations, the answers were correct in 58% and 50% when checking the pulse for 10 and 30 seconds, respectively. In the situation with a weak pulse, the answer was correct in 83% when checking the pulse for 10 seconds. In situations with a normal pulse, the answers were correct in 92%, 84%, and 84%, respectively, when checking the pulse for 10 (twice) and 30 seconds. The exactitude of the answer was correlated with the pulse strength (p \ 0.05). The degree of conviction about the answer was correlated with the exactitude of the answer (p \ 0.01) and the pulse strength (p \ 0.0001). Conclusions: These results question the routine use of the carotid pulse check during cardiopulmonary resuscitation, including for health care providers.

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Section: Discussionmentioning

confidence: 99%

mentioning

confidence: 99%

Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

Lapostolle

Toumelin

Agostinucci

et al. 2004

Academic Emergency Medicine

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“…Tab. 4; [416,417,418,419,420,421,422]). Aus letztlich unklaren Gründen werden in den letzten 5 Jahren die publizierten Überlebensra-ten besser als zuvor berichtet (.…”

Section: Allgemeinesunclassified

Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall

Soar

Perkins

Abbas³

et al. 2010

Notfall Rettungsmed

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“…All studies [1,3,4] reporting higher survival with significantly larger proportions of patients in severe shock had a more recent onset of cardiopulmonary resuscitation than those studies with a lower survival rate. However, whereas the duration of the arrest affects greatly the decision to perform an ET, the exact time of the trauma and the length of the 'down time' are in most of the cases uncertain.…”

mentioning

confidence: 91%

“…The ATLS guidelines regarding ET make recommendations solely on the basis of mechanism of trauma and do not take into account the duration of the arrest [1,7]. All studies [1,3,4] reporting higher survival with significantly larger proportions of patients in severe shock had a more recent onset of cardiopulmonary resuscitation than those studies with a lower survival rate.…”

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confidence: 99%

Appendix A. Editorial comment

Athanassiadi

2004

European Journal of Cardio-Thoracic Surgery

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Dr Kshivets: Sometimes the traditional method, biometrics matches the system, although you didn't find any predictors, but using neural networks computing, and at last simply knowledge engineering and expert system technology you may find these predictors.Dr Athanasiou: Yes. Dr Kshivets: And these predictors you can verify on learning samples. Dr Athanasiou: I have an answer. You asked me if we can use neural networks in our series. It has been published already by Tim Coats, who is Professor of Emergency Medicine in the Royal London and it was found that didn't have any better ROC curve performance in comparison to multivariate models. The multivariate models have a big disadvantage in that they can identify only patients at very high risk, with high incidence. So basically there is not an efficient way to identify the patients who will survive after emergency thoracotomy. We are concentrating on other types of models to analyze these data.Dr F. Vyhnanek (Prague, Czech Republic): We know it is a problem, emergency thoracotomy in blunt injury. Do you have some experience with emergency thoracotomy in serious blunt injury of the abdomen?Dr Athanasiou: We know that blunt trauma has a very bad outcome when we perform emergency thoracotomy, and what we have found as well is that between the years 1991 to 1993 we performed many thoracotomies and the majority of them were from blunt injury, and the results showed that we didn't have any survivors. So we introduced a new algorithm for penetrating injury which has been published in the Journal of Trauma.Emergency thoracotomy (ET) as a life-saving measure either in a prehospital or hospital setting remains a controversial procedure. Its role in traumatic cardiac arrest is defined as resuscitative allowing the evacuation of pericardial tamponade, direct control of intrathoracic hemorrhage, open cardiac massage and cross-clamping of the descending aorta.In this issue of the European Journal of Cardiothoracic Surgery the authors Athanasiou et al. have reviewed their experience with ET in a prehospital or hospital setting (53 patients in 9 years) with a high survival rate of 18.8% and suggest that ET might be a significant procedure in a well-selected group.Although cardiopulmonary arrest after trauma is associated with a poor prognosis, there are also other reports on the use of resuscitative thoracotomy in the emergency department that seem to hold some promise for injured patients with cardiopulmonary arrest [1 -6]. Generally, the ET literature consists of retrospective series suffering from methodological limitations. Analysis of this literature turns to be really complicated. Survival rates vary from 2 to 31% [7] but have not always been correlated with the mechanism and location of injury, the field and transport times, the duration of arrest and the physiologic status of the patient. Often survival data do not present neurologic outcomes in survivors.The ATLS guidelines regarding ET make recommendations solely on the basis of mechanism of trauma and do not take into ac...

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Field Triage of the Pulseless Trauma Patient

Cited by 117 publications

References 12 publications

Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

Basic Cardiac Life Support Providers Checking the Carotid Pulse: Performance, Degree of Conviction, and Influencing Factors

Kreislaufstillstand unter besonderen Umständen: Elektrolytstörungen, Vergiftungen, Ertrinken, Unterkühlung, Hitzekrankheit, Asthma, Anaphylaxie, Herzchirurgie, Trauma, Schwangerschaft, Stromunfall

Appendix A. Editorial comment

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