Traumatic Cardiac Arrest

Traumatic Cardiac Arrest

Traumatic cardiac arrest (TCA) is a distinct clinical state from medical cardiac arrest. The common causes are rapidly reversible mechanical or hypovolaemic insults (massive haemorrhage, tension pneumothorax, cardiac tamponade, severe hypoxia).

Management must prioritise rapid correction of those causes rather than following a routine ALS sequence-simultaneous, goal‑directed interventions and early use of hospital resources (Massive Haemorrhage Protocol, theatre/IR) are essential (Resuscitation Council UK; NICE NG39; RCEM).

Pathophysiology and guiding principle

• In TCA the arrest is usually secondary to loss of circulating volume or mechanical obstruction of cardiac filling/airflow.
• Chest compressions alone rarely restore meaningful perfusion unless the underlying cause is corrected.
• The primary aim is to restore perfusion by, in parallel:
• controlling catastrophic bleeding,
• decompressing the thorax/pericardium where indicated,
• securing oxygenation,
• delivering blood products and haemostatic therapy.
• Interventions that directly reverse these causes take priority over prolonged compressions (Resuscitation Council UK; NICE NG39).

Initial organisation and leadership

• Activate the trauma team and Massive Haemorrhage Protocol (MHP) immediately on suspicion of TCA.
• Notify theatre and interventional radiology early.
• Clear leadership and pre‑assigned roles improve performance: