Report on Multi-Trauma Cardiac-Arrest: Pathophysiology and Treatment

This report delves into the critical topic of multi-trauma cardiac arrest, examining its multifaceted nature and the associated challenges in patient care. It begins with a concise definition of cardiac arrest and underscores the poor outcomes often observed in multi-trauma cases. The report then explores the primary causes of morbidity and mortality, with a particular emphasis on brain injury, myocardial dysfunction, systemic ischemia, and persistent precipitating pathologies. It details the complex mechanisms of brain injury, including ischemia, reperfusion failures, and microvascular obstruction, as well as the clinical indicators such as coma and neuro-cognitive dysfunction. Furthermore, the report discusses the impact of cardiac arrest on myocardial function, the implications of systemic ischemia on multiple organ failure, and the contribution of various pathologies like pulmonary embolism and sepsis. The report concludes by highlighting the unique pathophysiology of multi-trauma cardiac arrest, which is often complicated by the initial injury and underlying comorbidities. This report provides a comprehensive overview of the subject, supported by relevant references, providing valuable insights for healthcare professionals and students alike.

Running head: MULTI-TRAUMA CARDIAC-ARREST 1
Multi-trauma Cardiac-Arrest
Student’s Name
Institutional Affiliation

MULTI-TRAUMA CARDIAC-ARREST 2
Introduction
A cardiac arrest is the cessation of cardiac mechanical action characterized by the
absence of signs of blood circulation such as a detectable pulse and apnoea. Multi-traumatic
cardiac arrest has been known to have poor results, with futile outcomes when resuscitation is
attempted, at a cost to medical and human resources. The preliminary cardiac rhythm for
most multi-trauma cardiac arrest patients is pulseless electrical activity, where the heart beats
but its pulse cannot be felt. The loss of a palpable pulse means that the patient experiencing
traumatic cardiac arrest has minimal active bleeding.
Brain injury
There are four main components and causes of morbidity and mortality in multi-
trauma cardiac arrest (Brady, Charlton, Lawner, & Sutherland, 2012, p. 51). The most shared
cause is injury to the brain. The exclusive susceptibility of the brain can be indorsed to its
minimal tolerance of ischemia and a completely unique response to reperfusion. Both or
either cardiac arrest or subsequent resuscitation attempts are responsible for various complex
mechanisms of brain injury for multi-trauma victims. These mechanisms include distressed
calcium homeostasis, free radical development, on-set of cell death, and excitotoxicity
conduits.
These various pathways are executed from within hours to days after successful
resuscitation (Morley, 2016, p. 67). Subpopulations of selectively vulnerable neurons in the
cerebellum, corpus striatum, hippocampus, thalamus and the cortex take hours to days to
degenerate, and both apoptosis and neuronal necrosis have both been reported following a
cardiac arrest.
Sustained cardiac arrest can be trailed by dynamic or fixed cerebral micro-circulatory
reperfusion failures regardless of enough pressure in cerebral reperfusion. Additionally, the

MULTI-TRAUMA CARDIAC-ARREST 3
diminished reflow can lead to obstinate ischemia and trivial infarction in some parts of the
brain (Zima, 2015, p. 167). The main source of the diminished reflow is cerebral micro-
vascular obstruction ascribed to intravascular thrombosis in the course of a cardiac arrest.
Away from the first reperfusion stage, various aspects can possibly inhibit delivery of
oxygen to the cerebral and cause secondary injuries in a span of hours to weeks after the
cardiac arrest event. The inhibitors comprise hypoxemia, hypotension elevated intracranial
pressure and brain oedema (Zima, 2015, p. 168). Transitory oedema in brain is observed after
resuscitation while delayed hyperaemia is responsible for delayed brain oedema.
The clinical indicators of multi-trauma cardiac arrest causing injury to brain include
seizures, coma, brain demise, neuro-cognitive dysfunction (Trzeciak, 2013, p. 130). Coma is
a state of unconsciousness of the brain areas accountable for awareness and arousal. Early
recovery of the brain could however constitute to a vegetative state, where only arousal and
sleep-wake phases preserved. Loss in coordination and movement may rise from damaged
motor associated centres in the cerebellum and cortex.
Myocardial dysfunction
Immediately after a prolonged resumption of spontaneous circulation, normal or
increased blood pressure and pulse rate can be as a result of a short-lived increment in
concentrations of circulating and local catecholamine (Morley, 2016, p. 67). Detection of
myocardial dysfunction occurrence can be detected within a few minutes of resumption of
circulation. However, prolonged depression of the ejection fraction can be reported over
weeks. The clinical evidence points to reversibility of the condition.
Systematic Ischemia
A multi-trauma cardiac arrest denotes the severest state of shock, as oxygen delivery
and metabolic material transport is instantly terminated and metabolites are also not ejected

MULTI-TRAUMA CARDIAC-ARREST 4
(Trzeciak, 2013, p. 132). Whole body ischemia with associative oxygen deficiency leads to
generalised stimulation of coagulation and immunologic pathways, leading to increased
danger of multiple organ-failure. Three hours from a cardiac arrest, soluble receptor
concentrations and various cytokines surge considerably and may encourage
immunosuppression.
Total body ischemia stress significantly affects adrenal functions. Most patients have
increased plasma cortisol level, relative adrenal insufficiency is common (Morley, 2016, p.
67). An inadequate activation of endogenous fibrinolysis after activation of blood coagulation
is a contributor to disorders from microcirculatory reperfusion.
Clinical manifestations include depletion of intravascular volume, impaired oxygen
delivery and use, impaired vasoregulation and increment in infection susceptibility (Zima,
2015, p. 170). Nevertheless, most of these pathologies are reversible or responsive to therapy.
Persistent Precipitation Pathology
The pathophysiology of after trauma cardiac-arrest diagnosis such as haemorrhage,
pulmonary diseases, acute coronary syndrome (ACD), sepsis, among others, are complicated
and can be complicate by the trauma. Pulmonary embolish has been reported to cause 2%-
10% of abrupt deaths, and no dependable data existing to predict the chances of the disease
(Nolan, 2017, p. 28). Chronic Obstructive Pulmonary Disorder (COPD) and pneumonia are
among pulmonary pathologies that may become worse after resumption of circulations
(Nolan, 2017, p. 28).
Multiple organ-failure is among most common cause of patient death in the intensive
care unit, reflecting on contribution of infections at the hospital. Sepsis is a disease that
causes multiple organ failure and acute respiratory distress syndrome.

MULTI-TRAUMA CARDIAC-ARREST 5
Conclusion
High death rates of patients who receive attempted resuscitation during a cardiac-
arrest resulting from trauma can only be explained by an exceptional pathophysiological
process that comprise multiple organ failure (Kuroda, 2019, p. 29). Unlike protracted full
body ischemia which leads to universal organ and tissue damage and extra damage during
and after reperfusion. Pathophysiology of multi-trauma cardiac-arrest is uniquely overlaid by
the injury that initiated the cardiac-arrest and the essential comorbidities. Psychotherapies
which emphasise on particular organs often comprise other affected organ and organ
structures.

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References
Brady, B., Charlton, N. P., Lawner, B. J., & Sutherland, S. F. (2012). Cardiac Arrest, An
Issue of Emergency Medicine Clinics - E-Book. St. Louis: Elsevier Health Sciences.
Kuroda, Y. (2019). Post-cardiac Arrest Syndrome (PCAS). Neurocritical Care, 165-173.
doi:10.1007/978-981-13-7272-8_13
Morley, P. T. (2016). Pathophysiology and causes of cardiac arrest. Oxford Medicine Online.
doi:10.1093/med/9780199600830.003.0061
Nolan, J. P. (2017). Cardiopulmonary resuscitation and the post-cardiac arrest
syndrome. Oxford Medicine Online.
doi:10.1093/med/9780199687039.003.0006_update_001
Trzeciak, S. (2013). Post–Cardiac Arrest Care. Emergency Department Critical Care, 87-96.
doi:10.1093/med/9780199779123.003.0008
Zima, E. (2015). Sudden Cardiac Death and Post Cardiac Arrest Syndrome. An
Overview. The Journal of Critical Care Medicine, 1(4), 167-170. doi:10.1515/jccm-
2015-0031