Cardiopulmonary arrest following penetrating trauma: guidelines for emergency hospital management of presumed exsanguination.

Exsanguination may be presumed in pale, mottled, unresponsive trauma victims with no palpable pulse nor spontaneous respirations with noncranial penetrating wounds. Under ideal circumstances, those victims initially witnessed to have some signs of life can be successfully revived in 5 to 25% of cases. The chance for a successful outcome influences the decision to initiate resuscitation and depends on the mode of injury, anatomic location of the wound, and elapsed time until presentation as well as the organization of the available facilities and personnel. The resuscitative algorithm for presumed exsanguination is markedly different from the ACLS guidelines for cardiogenic arrest and requires some degree of surgical expertise. After confirming the witnessed cardiopulmonary arrest from presumed exsanguination, the four phases of resuscitation are restoring central oxygenation, controlling internal hemorrhage, re-establishing spontaneous cardiac function, and definitively repairing the injury. Regardless of the type or location of the noncranial penetrating injury, these phases must be accomplished sequentially to minimize the risks of cerebral and cardiac anoxia.