Unlocking survival in traumatic cardiac arrest: global insights, innovations, and unmet needs.
Critical care (London, England) · 2025-10-24 · Scoping review
Abstract
Traumatic cardiac arrest (TCA) remains one of the most formidable challenges in acute care, with global survival rates persistently below 7.5% despite significant advances in trauma systems and resuscitative strategies. Through a comprehensive scoping review of literature from 2016 to 2025, this study delineates the shifting epidemiology, modern management, and key determinants of outcomes in TCA. Our synthesis reveals that TCA predominantly affects young males and results primarily from blunt mechanisms, with severe hemorrhage and traumatic brain injury as leading critical lesions. While pioneering interventions such as resuscitative endovascular balloon occlusion of the aorta and emergency resuscitative thoracotomy have been widely adopted, robust evidence for their survival benefit remains limited and context dependent. Early identification and correction of reversible causes, targeted hemorrhage control, and timely application of advanced life support measures-especially prehospital thoracostomy and vascular access-significantly increase the likelihood of return of spontaneous circulation and favorable neurological outcomes. Conversely, routine use of epinephrine shows at best inconsistent benefits and may be detrimental in blunt trauma. Survival is further influenced by initial rhythm, presence of signs of life, rapid patient triage to trauma centers, and tailored protocols for pediatric and older populations. Notwithstanding notable progress, major knowledge gaps persist in defining optimal intervention timing, reporting standards, and long-term neurologic recovery. The findings underscore the critical need for multicenter, prospective research, harmonized trauma registries, and global consensus to inform future guidelines and optimize outcomes for TCA patients.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Adrenaline · Cardiovascular drugs · Intravenous access · Mortality & survival · Quality of life & function · REBOA · Resuscitative thoracotomy · Thoracostomy
Related articles
- Intraosseous and Intravenous Epinephrine Administration Routes in Out-of-Hospital Cardiac Arrest: Survival and Neurologic Outcomes. (J Am Heart Assoc, 2024)
- Impact of intravenous accessibility and prehospital epinephrine use on survival outcomes of adult nontraumatic out-of-hospital cardiac arrest patients. (BMC Emerg Med, 2024)
- Characteristics and outcome of traumatic cardiac arrest at a level 1 trauma centre over 10 years in Sweden. (Scand J Trauma Resusc Emerg Med, 2022)
- Prehospital care for traumatic cardiac arrest in the US: A cross-sectional analysis and call for a national guideline. (Resuscitation, 2022)
- Intraosseous Versus Peripheral Intravenous Access During Out-of-Hospital Cardiac Arrest: a Comparison of 30-Day Survival and Neurological Outcome in the French National Registry. (Cardiovasc Drugs Ther, 2020)
- Prehospital intravenous access for survival from out-of-hospital cardiac arrest: propensity score matched analyses from a population-based cohort study in Osaka, Japan. (BMJ Open, 2017)