Prehospital Management of Traumatic Cardiac Arrest: A Narrative Review of Evidence and Implications for Emergency Nursing.
Journal of emergency nursing · 2026-01-05 · Other / unclear
Abstract
INTRODUCTION: Traumatic cardiac arrest represents 1 of the most challenging emergencies in trauma care, historically associated with dismal survival and frequent perceptions of futility. This narrative review synthesizes contemporary evidence on the epidemiology, prognostic determinants, and management strategies for traumatic cardiac arrest, with emphasis on prehospital interventions and trauma system organization. METHODS: This review was reported in accordance with the Scale for the Assessment of Narrative Review Articles to support methodological transparency and reporting quality. PubMed, CINAHL, and Scopus were searched to identify studies addressing the epidemiology, pathophysiology, and management of traumatic cardiac arrest. Eligible sources included registry analyses, observational studies, reviews, consensus documents, and position statements. Evidence was narratively synthesized to identify consistencies, gaps, and operational priorities across emergency medical services systems. RESULTS: Reported survival after traumatic cardiac arrest remains low, generally <10%, although selected subgroups demonstrate higher survival depending on mechanism of injury, system configuration, and availability of advanced interventions. Prognosis is strongly influenced by early correction of reversible causes such as hemorrhage, hypoxemia, tension pneumothorax, and cardiac tamponade, summarized in the hypovolemia, oxygenation impairment, tension pneumothorax, and tamponade framework. Evidence demonstrates variable effectiveness of conventional chest compressions and vasopressors, while supporting early thoracic decompression, hemostatic resuscitation, and prehospital blood product administration. Physician-staffed helicopter emergency medical services teams may provide additional benefit through early definitive interventions, although substantial heterogeneity persists across trauma systems. DISCUSSION: Despite persistently high mortality, outcomes may improve when reversible causes are corrected rapidly, hemostatic resuscitation is initiated early, and system-level coordination is optimized. Current evidence remains heterogeneous and predominantly observational; future research should validate cause-first algorithms, refine prognostic tools, and evaluate prehospital strategies and emergency nursing practices for traumatic cardiac arrest management across diverse emergency medical services systems and emergency care settings.
Tags
Blood products · Cardiovascular drugs · Fluids & blood · Needle decompression · Thoracostomy · Vasopressors