Blood transfusion therapy for traumatic cardiopulmonary arrest

An Overview of Therapy Guidelines for Cardiac Arrest and the Potential Benefits of Hemoglobin-Based Oxygen Carriers

Currently, there is an unmet therapeutic need for the medical management of cardiac arrest, as is evident from the high mortality rate associated with this condition. These dire outcomes can be attributed to the severe nature and poor prognosis of this disorder. However, the current treatment modalities, while helping to augment survival, are limited and do not offer adequate improvements to outcomes. Treatment modalities are particularly lacking when considering the underlying pathophysiology of the metabolic phase of cardiac arrest. In this study, we explore the three phases of cardiac arrest and assess the factors related to positive clinical outcomes and survival for these events. Furthermore, we evaluate the present guidelines for resuscitation and recovery, the issues related to ischemia and tissue reperfusion, and the benefit of oxygen-delivery therapeutic methods including blood transfusion therapy and synthetic hemoglobins (HBOCs). The current therapy protocols are limited specifically by the lack of an efficient method of oxygen delivery to address the metabolic phase of cardiac arrest. In this article, we investigate the next generation of HBOCs and review their properties that make them attractive for their potential application in the treatment of cardiac arrest. These products may be a viable solution to address complications associated with ischemia, reperfusion injury, and organ damage.

Clinical Manifestations and Effects of In-Hospital Resuscitative Procedures in Patients with Traumatic Out-of-Hospital Cardiac Arrest from Three Hospitals in Southern Taiwan

BACKGROUND

The prognosis of patients with traumatic out-of-hospital cardiac arrest (TOHCA) is poor. Few studies have evaluated whether the commonly conducted in-hospital resuscitative interventions have beneficial effects on the return of spontaneous circulation (ROSC) and survival rate in patients with TOHCA. Therefore, we conducted a retrospective study to reveal the clinical manifestations of patients with TOHCA in Southern Taiwan and evaluate the effectiveness of variouscommon in-hospital interventions in these patients.

METHODS

This retrospective chart review of patients with TOHCA was conducted in three hospitals in Southern Taiwan between January 1, 2014, and December 31, 2016, to demonstrate the characteristics of patients with TOHCA and compare the differences in in-hospital interventions before ROSC between ROSC and non-ROSC groups.

RESULTS

In total, 272 patients with TOHCA were reviewed; their average age was 50.7 years, and men constituted the predominant sex (73.2%). Moreover, 91 patients (33.5%) experienced at least transient ROSC, 40 patients (14.7%) were admitted to hospitals, and 4 patients (1.5%) survived to hospital discharge. The ROSC and non-ROSC groups did not differ in in-hospital interventions, including chest tube and central venous catheter insertions, defibrillation, and pressor infusion. However, the non-ROSC group had a higher rate of transfusion than the ROSC group (17.7% vs. 6.6%, p = 0.015).

CONCLUSION

The outcomes of patients with TOHCA in Southern Taiwan remained dismal. None of the in-hospital interventions, including blood transfusion, chest tube and central venous catheter insertions, defibrillation, and pressor infusion, were determined to be beneficial for patients with TOHCA. We suggest that these in-hospital interventions should not be routinely performed in every patient with TOHCA.