42 - A NATIONAL SURVEY ASSESSING THE VARIABILITY IN THE MANAGEMENT OF TRAUMATIC CARDIAC ARREST

Objectives: National guidelines for managing traumatic cardiac arrest do not exist. Some trauma surgeons practice Advanced Trauma Life Support (ATLS)-only models while others utilize Advanced Cardiac Life Support (ACLS). The study aim was to determine trauma surgeon practices in traumatic cardiac arrest activations and to examine differences in the use of ACLS including medications, duration, indications, outcomes and respondent age, gender, years in practice, and state. We hypothesized that the practice of ACLS would vary significantly.

Methods: A mixed-methods approach was applied. A web-based survey was distributed to 1,680 members of the American Association of the Surgery of Trauma over six weeks. Respondent age, gender, years in practice, and region were assessed along with management of traumatic cardiac arrest. Chi-squared tests were completed to determine statistical significance (p < 0.05). Qualitative data was obtained via open-ended questions regarding legal, ethical or interpersonal conflicts associated with the use or lack of use of ACLS in traumatic cardiac arrest; coding and analysis were performed by ATLAS.ti.

Results: Two-hundred and three surveys were completed (12% response rate) over six weeks. Overall, 73.4% of respondents reported utilizing ACLS, while 26.6% reported they never utilize ACLS. ACLS was significantly associated with surgeon age (p=0.049), years in practice (p=0.025) and state of practice (p=0.006). The medications utilized, duration, and indications for ACLS application were highly variable. Of those that used ACLS, some utilized a medication-only approach while others performed chest compressions only. There was no difference in self-reported survival rates between those that utilized ACLS and those that did not. Qualitative data analysis revealed themes of futility, the need to “do something” and excessive use of limited resources. Qualitative data also demonstrated ACLS in traumatic cardiac arrest was a significant source of interpersonal conflict both between specialties and between physicians and staff.

Conclusion: These findings show that one quarter of surgeons never utilized ACLS in the setting of traumatic cardiac arrest. Furthermore, the use of ACLS techniques was highly variable with no consistency on indications, duration, or medications utilized. Outcomes appear to be equivalent regardless of use of ACLS. Qualitative data analysis shows this is a highly contentious area and a significant source of interpersonal conflict. While methodologically sound, low response rate was a study limitation. This study shows that the management of traumatic cardiac arrest is entirely surgeon-specific and highlights the need for national guidelines in order to standardize practice in a controversial area.