Traumatic Cardiac Arrest
Traumatic cardiac arrest (TCA) is cardiac arrest following major blunt or penetrating injury. Unlike primary medical arrest, the immediate causes are frequently mechanical or haemorrhagic (catastrophic bleeding, tension pneumothorax, cardiac tamponade, airway obstruction).
Successful resuscitation therefore depends on rapid, organised treatment of reversible causes rather than a strict medical ALS sequence.
The Royal College of Emergency Medicine (RCEM) and Resuscitation Council UK (RCUK) emphasise simultaneous prioritisation of haemorrhage control, oxygenation/ventilation and chest decompression, supported by early blood product resuscitation and focused ultrasound.
Principles
- Prioritise reversible traumatic causes: control catastrophic haemorrhage, decompress the chest, secure the airway/ventilate, stabilise the pelvis and deliver rapid transfusion.
- Use a pre‑defined team structure and a TCA checklist/algorithm so multiple interventions can occur in parallel.
- Use point‑of‑care ultrasound (POCUS: FoCUS/e‑FAST) to identify tamponade, cardiac activity, pneumothorax and major intra‑abdominal bleeding to guide interventions and prognosis.
- Chest compressions must not delay definitive interventions for reversible mechanical causes; they remain part of care when no treatable cause is identifiable or while interventions are being organised (RCEM; RCUK).
Pathophysiology - what to look for TCA commonly results from:
- Severe hypovolaemia from external or internal bleeding (pelvis, major vessels, solid organs).
- Massive chest injury causing tension pneumothorax or massive haemothorax.