Traumatic cardiac arrest: what's HOT and what's not

Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting and has a varied aetiology. Paramedic management has changed significantly over the past 5 years. Chest compressions have been de-emphasised in guidelines, and the ‘HOT’ principles have been adopted. This principle stands for hypovolaemia; oxygenation; tension pneumothorax/tamponade. The recommendation is that these should be addressed prior to performing chest compressions. There may however be patient groups in TCA who benefit from chest compressions. A management plan including ‘no chest compressions’ for TCA is not supported in the evidence, and they should be commenced as soon as appropriate reversible causes have been addressed. In addition, chest compressions may take precedence over the administration of fluid if both cannot be performed simultaneously. Ambulance services may improve management of TCA by the introduction of an aide-memoire to support clinicians.

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