Pre-hospital management of traumatic cardiac arrest 2024 position statement: Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh
Faculty of Pre-Hospital Care, RCSEd · 2024 · United Kingdom
Source and licence
- Authors
- Celestine Weegenaar, Zane Perkins, David Lockey
- Title
- Pre-hospital management of traumatic cardiac arrest 2024 position statement: Faculty of Prehospital Care, Royal College of Surgeons of Edinburgh
- Journal
- Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine, 2024
- Licence
- CC BY 4.0
- Changes
- Verbatim excerpts; formatting adapted
Full text retrieved 2026-10-27 from Europe PMC · PMC11686978
Licence statement of the original publication
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This page reproduces excerpts of the original publication; the original is authoritative. It has not been reviewed by a physician, does not state a recommendation of Medelix and does not replace medical advice. The guideline may have been updated since.
Open the original publication →Full text on Europe PMC
Recommendations
Verbatim, with grade of recommendation or strength of consensus where given.
The challenges of TCA in the pre-hospital setting
- RecommendationPre-hospital teams must rapidly evaluate critically unwell trauma patients and consider what resources are available on scene. Reversible pathologies must be rapidly identified, addressed and, where possible, rapid transfer carried out to an appropriate hospital.
- RecommendationPositive pressure ventilation can precipitate TCA in patients with hypovolaemia, cardiac tamponade or tension pneumothorax. These pathologies must be treated immediately if deterioration occurs.
Reversible causes of TCA
- RecommendationAddressing reversible factors in TCA is time critical. Use a standardised approach to address reversible factors simultaneously.
- RecommendationAddressing the reversible causes of TCA has greater priority than chest compressions. Chest compressions are carried out with in normovolaemic TCA or where a medical cardiac arrest has preceded the traumatic episode.
- RecommendationIf medical cardiac arrest is suspected deliver standard ALS interventions.
Hypovolaemia
- RecommendationRapidly control external haemorrhage.
- RecommendationResuscitative thoracotomy is an established pre-hospital intervention in some pre-hospital services with doctor-practitioner teams. Where trained providers are available it is conducted as soon as possible after cardiac arrest. It is primarily indicated in penetrating chest trauma.
- RecommendationThe evidence for benefit of REBOA and other aortic occlusion techniques are not yet established in advanced pre-hospital practice. These techniques should only be carried out as part of research studies or subject to specific patient indications and local protocols in services with comprehensive training and governance. These techniques must not delay definitive haemorrhage control.
- RecommendationBlood and blood products are used early in resuscitation to manage hypovolaemia wherever possible. Local protocols currently determine the types of blood product used. Crystalloid solutions are not recommended unless cardiac arrest is imminent and blood products are not available.
Hypoxaemia
- RecommendationCorrection of hypoxia is an immediate priority in TCA. Immediately administer high flow oxygen to patients in TCA. Airway patency and adequate ventilation is achieved with basic or more advanced airway interventions depending on the skills of attending providers.
Tension pneumothorax
- RecommendationIn TCA decompress the chest with rapid bilateral thoracostomy or commercially available large bore needle decompression devices if thoracostomy is not available.
Cardiac tamponade
- RecommendationCardiac tamponade causing TCA is rapidly fatal and must be immediately evacuated by thoracotomy on scene or, where not available, in the emergency department.
Ultrasound
- RecommendationUltrasound is a useful diagnostic pre-hospital tool but must not delay treatment of reversible pathologies.
Paediatric traumatic cardiac arrest
- RecommendationThe priorities for paediatric TCA are essentially the same as for adult TCA with particular emphasis on early hypoxaemia management. Paediatric provider skills must be regularly refreshed for this less common event.
Traumatic cardiac arrest in the obstetric patient
- RecommendationResuscitation of maternal TCA is be focussed on the same priorities as non-pregnant patients with uterine displacement and a focus on maternal survival.
Contents of the original publication
The section headings of the original.
- Introduction
- The challenges of TCA in the pre-hospital setting
- Reversible causes of TCA
- Hypovolaemia
- Hypoxaemia
- Tension pneumothorax
- Cardiac tamponade
- Ultrasound
- Paediatric traumatic cardiac arrest
- Traumatic cardiac arrest in the obstetric patient
- Termination of resuscitation
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