Unlocking survival in traumatic cardiac arrest: global insights, innovations, and unmet needs

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.