Traumatic cardiac arrest (TCA) is a condition in which the heart has ceased to beat due to blunt or penetrating trauma, such as a stab wound to the thoracic area.^[1] It is a medical emergency which will always result in death without prompt advanced medical care. Even with prompt medical intervention, survival without neurological complications is rare.^[2] In recent years, protocols have been proposed to improve survival rate in patients with traumatic cardiac arrest, though the variable causes of this condition as well as many coexisting injuries can make these protocols difficult to standardize.^[3] Traumatic cardiac arrest is a complex form of cardiac arrest often derailing from advanced cardiac life support in the sense that the emergency team must first establish the cause of the traumatic arrest and reverse these effects, for example hypovolemia and haemorrhagic shock due to a penetrating injury.^{[citation needed]}

Traumatic cardiac arrest can occur in patients following any severe blunt or penetrating injury to the chest. Following the traumatic event, the heart ceases to pump blood through the body. Unlike medical cardiac arrest, there are several potentially reversible causes that may result in cardiac arrest in the setting of trauma. Clinicians will rapidly assess for these causes, and interventions will be directed to the specific cause.^[4]

Patients will present following a traumatic event most often with pulseless electrical activity (PEA). Patients will exhibit low blood pressure with pulses that cannot be palpated. Patients will progress into asystole if the underlying condition is not reversed. Other non-specific signs and symptoms associated with impending traumatic cardiac arrest may include sweating, altered mental status, rapid or slow breathing, and signs of trauma (bruising, laceration, fractures, etc.).^[4]

Diagnosis of traumatic cardiac arrest is initially made with electrocardiogram with EMS or in the emergency department. Clinicians will also order diagnostic testing that may include chest x-ray, bedside ultrasound and echocardiogram, and blood gas levels. A type and cross will be ordered to match the patient to receive blood transfusion if necessary.

Other work-up involved in diagnosis of a trauma patient may include e-FAST, RUSH exam, CBC, pelvic X-ray, and CT of the head, neck, chest, abdomen, and pelvis.

Treatment of traumatic cardiac arrest is guided by advanced trauma life support guidelines. Standard advanced cardiac life support guidelines are inappropriate for use in traumatic cardiac arrest, as they are directed primarily at treating pathology originating within the heart itself.^[5] As clinicians begin to intervene, they will simultaneously seek reversible causes of the arrest. Management begins by establishing multiple points of IV access and evaluating the patient's airway and breathing. Other interventions may include thoracostomy and thoracotomy, as well as treatment of the underlying cause of arrest.

Historically, traumatic cardiac arrest was thought to lead invariably to death. More recently, evolutions of advanced trauma life support guidelines and improved understanding of the underlying causes of traumatic cardiac arrest have improved outcomes for patients.^[5] Recent studies suggest that the survival rate for traumatic cardiac arrest is similar to that of all-cause cardiac arrest.^[6] There is wide variability in the estimated survival rate based on factors that include initiation of pre-hospital care and nature of injury.^[7]

Many patients who survive traumatic cardiac arrest may develop long-term neurological damage resulting from lack of circulation to the nervous system during the arrest. This damage may range from moderate disability to a persistent vegetative state. A 2012 review suggests that while survival rates of traumatic cardiac arrest are higher in children, so is the incidence of neurological complication.^[8]