It was great to attend the inaugural Focused Trauma Conference hosted at the University of Antwerp. Although run with a Belgian slant on things there were a number of British speakers and the whole event was in English which was useful for my dotard ears as one of the few uni-linguists in the audience. The venue was amazing.
Thanks to the breaks the day roughly broke up into three sections with different topics explored. So, like the aorta in REBOA, (more of that later) we will tackle the day in three parts.
In the first part Professor Nijs began by exploring major trauma in Belgium. Belgium has twice the mortality rate due to trauma of the UK and has no system of Quality Assurance. I was really proud to be part of the NHS as he highlighted the improvements seen in the UK since the MTC network was set up. Whilst he pointed out that all systems need a 5 year maturation period in the UK we had seen immediate improvements in outcomes which increased year on year. Major Trauma is an area of constantly changing paradigms: we no longer consider traumatic cardiac arrest a futile endeavour and there are ever improving methods of haemorrhage control such as REBOA. He feels Belgium should aspire to the UK model but they will need:
1. The resources
2. People who understand
3. People who have the skills
Dr Ed Barnard (@edbarn) then spoke about traumatic cardiac arrest (TCA). There is no universal definition of traumatic cardiac arrest which makes research difficult but this is predominately a disease of young people. Whilst initial papers gave low survival rates recent Trauma Audit and Research Network (TARN) data from 2009-2015 shows a 7.5% survival to hospital discharge rate as well a 2/3 moderate to good neurological outcome post TCA. He discussed methods of public engagement as well as distinguishing between low output states in trauma (LOST) and no output states in trauma (NOST). Whilst the standard methods of controlling bleeding and IV filling may work in LOST the future of resuscitation in NOST may involve methods of controlling and providing flow such as selective aortic arch perfusion.
In the final talk of part one discussed the European Resus Council (ERC) algorithm for TCA,
Universal cardiac arrest algorithms are not suitable for TCA as they can result in delays of nearly 10 minutes whilst looking for a reversible cause such as tension pneumothorax. The ERC algorithm places chest compressions at a lower priority in TCA than treating hypoxia, tension pneumothorax, tamponade and hypovolaemia. Dr Truhlar (@TruhlarA) openly admitted that the role of CPR is unknown.
The only nation to reject the ERC guidelines was the UK (insert Brexit reference) with the UK Resus Council producing its own guidelines as above which keeps thoracostomy and needle decompression as considerations not standard practice for all TCA.
Dr Monsieurs (@kmonsieurs) continued this debate of the role of chest compressions in TCA. He felt that maybe chest compressions provide little benefit in TCA and get in the way of other things which provide much more benefit. There was discussion about how hard it can be for a professional to stop CPR for other procedures once bystanders have been doing compressions after calling for help. Dr. Barnard made the interesting point that chest compressions whilst improving systolic BP cause diastolic BP to drop and so reduce coronary perfusion.
I think the role of chest compressions in TCA and the ERC and UK TCA algorithms will provide much more fuel for research in the years to come!
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