AP267 Low cardiac output state in non traumatic cardiac arrest
Alessandro Valentino1, Sara De Stefani2
1 Major Trauma department, Bufalini Hospital, Italy. 2Modena University, Italy

Abstract
Recentely published data have shown that traumatic cardiac arrest  (TCA) has similar otcome than medical cardiac arrest (MCA).
The improve of the outcome seen in the last years is given by a different approach in the treatment of TCA.
In TCA the initial cardiac rhythm is tipically pulseless electrical activity (PEA); in this clinical situation the heart is often beating but we can't feel the arterial pulse for a very low output state.
This new knowledge has changed the approach to TCA and the team efforts are to treat the cause of cardiac arrest rather than performing CPR.
The introduction of the ultrasonography in the algorithm of medical cardiac arrest showed that a mechanical cardiac activity is really present in the 75% of the cases in situation of PEA.
So we want introduce the concept of low output cardiac state (LCOS) in non traumatic cardiac arrest to change the approach to PEA.
We are sure that in MCA when the rhythm is PEA there is very often an underlying LCOS.
We have a case report about an young man in traumatic cardiac arrest by a tensive pneumotorax, acute hemorrage and cardiac tamponade caused by a penetrating trauma of the left chest saved without performing chest compressions, treated with pericardic and pleuric drenage and with blood tranfusions.
We present also four cases about MCA caused by pulmunary thromboembolism in which we stopped CPR after sistemic thrombolysis when the ultrasonography showed mechanical cardiac activity.
All these patients were discharged without neurological disability.
So we think that in situations of LCOS the return of spontaneus circulation (ROSC) is possible only if the resuscitation team quickly finds and treats the underlyng cause of cardiac arrest and that CPR in PEA is often not necessary.

3 - Low cardiac output state in non traumatic cardiac arrest