Traumatic cardiac arrest, what clinicians and researchers must know

Survival rates for trauma cardiac arrest (TCA) routinely range from 2 to 5% and have not improved in high-income countries over the past two decades, unlike those for medically induced cardiac arrests. This persisting low TCA survival rates have led to debates, about the value of resuscitating TCA patients, considering the significant risks and costs involved compared to the low chances of favorable outcomes. As well, TCA patients are frequently excluded from large randomized controlled trials on cardiac arrest management, with most research consisting of retrospective studies and clinical case series. The causes of cardiac arrest following injury are diverse, and hypovolemia, particularly from hemorrhagic shock, is a significant cause of early death. Direct cardiac or large vessel injuries, such as myocardial contusions or tamponade, can also lead to TCA. While TCA from severe brain or spinal injuries are less frequent, survival rates in these cases can be slightly better if return of spontaneous circulation (ROSC) is achieved. The presence of bystander CPR, shockable initial rhythms, and rapid identification and treatment of reversible causes are associated with favorable outcomes. A few strategies should be applied systematically, such as early bleeding source control, oxygen supplementation, hypovolemia correction, and diagnosing and treating compressive pleural or pericardial effusions. Emerging techniques are suggested for the management of refractory hemorrhagic shock and cardiac arrest, such as the REBOA (Resuscitative Balloon Occlusion of the Aorta), but further research is needed to determine the most effective approaches to prehospital and in-hospital TCA management.