Should we do cardiac compressions in hemorrhagic shock?

A study in the Journal of Trauma and Acute Care Surgery investigates the value of chest compression in canine patients with traumatic blood loss. Cardiopulmonary resuscitation (CPR) is designed for sudden cardiac events usually triggered by thrombosis, but chest compressions have been employed in trauma resuscitations per the American Heart Society human guidelines. However, there is no data showing the benefit of chest compression in animal trauma patients with hemorrhagic shock

Study details

Eighteen canine subjects were anesthetized and then were hemorrhaged until pulse loss and then for 30 more minutes. Then they were resuscitated for 20 minutes. The dogs were divided into three resuscitative treatment groups, consisting of six dogs each: a CPR only group, a CPR plus fluids group and a group with fluid therapy only. Two of six dogs in the CPR only group were not able to be resuscitated, while all dogs were able to be resuscitated in the CPR plus fluids or fluids only groups. At the end of the study, tissue samples were evaluated to assess organ damage, and the dogs in the CPR only group were found to have more episodes of end organ damage.

Your emergency room application

The researchers deduced that there appears to be no benefit to chest compression in hemorrhagic shock in their study. Adding chest compressions in addition to fluid therapy did not seem to reverse the signs of shock better than fluid therapy alone. Further investigation is needed to say if there is a role for chest compressions in a trauma patient with hemorrhagic shock.

Jeffcoach DR, Gallegos JJ, Jesty SA, et al. Utility of CPR in hemorrhagic shock, a dog model. J Trauma Acute Care Surg 2016; Epub ahead of print.

Link to abstract: http://www.ncbi.nlm.nih.gov/pubmed/26895089