Accession Number : ADA616642


Title :   Re: Traumatic Cardiorespiratory Arrest on the Battlefield


Descriptive Note : Journal article


Corporate Author : ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX


Personal Author(s) : Morrison, Jonathan J ; Poon, Henrietta ; Rasmussen, Todd E ; Khan, Mansoor A ; Garner, Jeffery P


Full Text : https://apps.dtic.mil/dtic/tr/fulltext/u2/a616642.pdf


Report Date : 01 Aug 2013


Pagination or Media Count : 3


Abstract : We are very grateful to Dr. Pasquier and colleagues for their thought provoking letter, discussing the role of cardiopulmonary resuscitation (CPR) on the battlefield. First, it is important to differentiate between cardiac arrest and circulatory arrest as a cause for the loss of a palpable central pulse. Primary cardiac arrest generally relates to nontraumatic causes such as arrhythmias, electrocutions and so on and reflects a primary problem with cardiac contractility. CPR is appropriate because there is a circulating volume present with which to perfuse the systemic circulation. Circulatory arrest, as in exsanguination from hemorrhagic shock, does not initially relate to a failure of cardiac contraction but reduced cardiac preload. Untreated circulatory arrest will eventually progress to cardiac arrest owing to a failure of systemic oxygenation. Circulatory arrest from hemorrhage is the leading cause of potentially preventable death among battlefield casualties and served as the main indication for resuscitative thoracotomy in our recent study. We are of the opinion that the management priorities in circulatory arrest are hemorrhage control and restoration of circulating volume. We do not believe that CPR is of benefit in such cases because there is no circulating volume with which to perfuse the systemic circulation. We reported 10 cases of arrest in the field; however, this does not mean that these patients received CPR. Indeed, as all the authors have deployed to Afghanistan, serving at all medical echelons, patients do not always receive CPR in the field, as per UK prehospital care guidelines. This largely relates to adverse tactical circumstances and other triage priorities. Furthermore, we are also unaware of any injuries sustained by a first-line care giver sustained during the performance of field CPR.


Descriptors :   *CARDIOPULMONARY RESUSCITATION , *MILITARY MEDICINE , CARDIAC ARREST , CARDIOVASCULAR SYSTEM , HEMORRHAGE , TRAUMA


Subject Categories : Medicine and Medical Research


Distribution Statement : APPROVED FOR PUBLIC RELEASE