🚨 Trauma-related cardiac arrest (TRCA) is a critical emergency where the heart stops effectively due to severe injury. Unlike medical cardiac arrest, TRCA usually has reversible mechanical or physiological causes (bleeding, hypoxia, tamponade) and requires a targeted trauma approach rather than standard ACLS.

Causes

🩸 Hypovolemia: severe internal/external haemorrhage.
🫁 Tension pneumothorax: lung collapse with mediastinal shift.
💔 Cardiac tamponade: pericardial blood/fluid compressing the heart.
🌬️ Hypoxia: airway obstruction or respiratory failure.
🫀 Massive PE: rare but possible after trauma.
❄️ Hypothermia: low core temperature impairs contractility.

Pathophysiology

Most TRCAs stem from 🩸 haemorrhagic shock → preload failure → PEA. Obstructive causes (tamponade, tension pneumothorax) prevent filling. 🌬️ Hypoxia worsens cellular dysfunction, precipitating arrest.

Assessment (ATLS framework)

🅰️ Airway: patency, C-spine control.
🅱️ Breathing: chest movement, auscultation, needle decompression if suspected tension.
🅲️ Circulation: pulses, haemorrhage control, IV/IO access.
🅳️ Disability: GCS, pupillary response.
🅴 Exposure: identify injuries, prevent hypothermia.

Management Principles

🏥 Key difference from medical arrest: Fix the cause (bleeding, tamponade, pneumothorax) rather than prolonged CPR + drugs. Chest compressions are adjunctive, not definitive.

Immediate Actions

⚠️ Scene safety and activate trauma team.
🤝 Call surgical/cardiothoracic backup early.
💨 Airway: intubate if indicated, give 100% O₂.
❤️ Start compressions only if no cardiac output.
🔎 Use POCUS/eFAST to check cardiac activity, tamponade, pneumothorax, bleeding.

Treating Reversible Causes

🩸 Hypovolemia: direct pressure/tourniquets, pelvic binder, TXA, MHP (1:1:1 RBC:plasma:platelets).
🫁 Tension pneumothorax: needle decompression ➝ chest tube.
💔 Tamponade: pericardiocentesis (temporary) ➝ resuscitative thoracotomy.
🌬️ Hypoxia: airway clearance, intubation, ventilation.
❄️ Hypothermia: warm blankets, warmed IV fluids, heated oxygen.

Adjuncts

🖥️ Ultrasound: assess cardiac motion (if none, prognosis poor).
⚡ Defibrillate if VF/VT present (rare in TRCA).
💊 Drugs: limited role-focus on surgical/trauma fixes.

Special Considerations

🔪 Resuscitative Thoracotomy: Indicated for penetrating thoracic trauma with signs of life in ED. Allows tamponade release, cardiac massage, aortic cross-clamp.
⏹️ Termination: Blunt trauma arrest without signs of life and no ROSC after reversible causes addressed → cease efforts (per ERC/RCEM guidance).

Prognosis

📉 Overall survival is < 5%. 🔪 Penetrating trauma (esp. cardiac stab wounds) → best outcomes. 🚗 Blunt trauma arrest → survival is extremely rare.

Conclusion

TRCA requires rapid recognition and immediate treatment of reversible causes. 💡 Unlike medical cardiac arrest, the emphasis is surgical: haemorrhage control, decompression, thoracotomy. Outcome depends on mechanism-penetrating > blunt.

References

ATLS 10th Ed. American College of Surgeons, 2018.
Soar J, Nolan JP, Böttiger BW, et al. ERC Guidelines, 2021.
Hopson LR, Hirsh E, Delgado J, et al. J Am Coll Surg 2003;196(1):106-112.

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Trauma: Cardiac Arrest

Introduction