Abstract
Background: Traumatic cardiac arrest during prolonged extrication presents significant physiologic challenges. While prehospital care traditionally relies on emergency medical services personnel, select systems deploy hospital-based teams capable of delivering advanced anesthetic and resuscitative interventions at the scene. Reports describing surgeon–Certified Registered Nurse Anesthetist (CRNA) mobile response teams in the United States remain limited.
Case Presentation: A 44-year-old male sustained a 60-foot fall with prolonged entrapment and bilateral lower extremity crush injuries. He was conscious initially but developed traumatic cardiac arrest during extrication following an additional 10-foot fall. A hospital-based mobile trauma team composed of a CRNA and a surgeon initiated definitive airway management, mechanical cardiopulmonary resuscitation, intraosseous and intravenous access, vasoactive therapy, metabolic resuscitation (calcium and bicarbonate), and prehospital blood transfusion. Return of spontaneous circulation was achieved after approximately nine minutes. Persistent shock required continued transfusion and resuscitative endovascular balloon occlusion of the aorta (REBOA) upon hospital arrival. Imaging demonstrated craniocervical dissociation with absent cerebral arterial flow. Injuries were deemed nonsurvivable.
Conclusion: This case demonstrates that hospital-level interventions can be successfully delivered in the prehospital setting by a surgeon–CRNA response team. Although the injury was ultimately fatal, early advanced resuscitation restored spontaneous circulation and permitted definitive diagnostic evaluation in the hospital. Mobile trauma teams may bridge the gap between prehospital and in-hospital care in select high-acuity scenarios.
Keywords
Prehospital anesthesia, Traumatic cardiac arrest, Crush injury, Hemorrhagic shock, REBOA, Trauma resuscitation