Traumatic cardiac arrest

Traumatic cardiac arrest (TCA) represents a distinct clinical entity from medical cardiac arrest, characterized by a higher prevalence of pulseless electrical activity (PEA) and potentially reversible underlying causes. Survival rates for TCA are notably higher than previously thought, with Australian data showing approximately 24-25% survival and significantly better outcomes for penetrating trauma compared to blunt force injuries. Successful resuscitation hinges on the rapid identification and treatment of reversible factors: managing hypovolemia with blood products instead of crystalloids, performing finger thoracostomies for tension pneumothorax, and utilizing resuscitative thoracotomy for cardiac tamponade. Management protocols must de-emphasize external chest compressions, which may be counterproductive in a hypovolemic or tamponaded heart, and instead prioritize surgical hemorrhage control and specialized trauma team interventions. Ultimately, the integration of skilled aeromedical services and primary transfer to high-capability trauma centers remains the strongest predictor of neurologically intact survival.