Chest Compressions in Trauma Cardiac Arrest

You are correct in stating that there are numerous other guidelines (ERC, ANZCOR, AHA, etc.) that speak to delaying CPR in traumatic cardiac arrests (TCA) to first manage reversible causes such as massive hemorrhage, airway, oxygenation, and tension pneumothorax.

Currently the RPPEO is not recommending delaying or withholding CPR in TCAs. The treatment algorithm for TCA in the ALS PCS states, “simultaneously address reversible causes” (hypovolemia, oxygenation, tension pneumothorax). What this means is that while one paramedic partner is starting resuscitation efforts such as CPR and defibrillation, the other paramedic can address those reversible causes. In the case of only one responder and you had to choose, you would address reversible causes first (open the airway, tourniquet, needle decompression) but CPR is indicated concurrently or immediately after.

Speaking specifically to airway management, and potentially intubating, CPR with basic airway management is best practice. Intubating a patient with questionable hemodynamics can be harmful. In cases of shock we generally recommend "resuscitate before you intubate" to avoid the hemodynamic collapse that can be associated with invasive positive pressure ventilation. Withholding CPR to first manage reversible causes might make sense intuitively, but it is not evidence-based, and not a reason to change standard practice at this time.

There is going to be ongoing controversy, and medics are going to hear questions about the utility of CPR in cases of hemorrhagic causes of death, and in these cases, CPR certainly isn’t as important as it is in sudden cardiac death from VF and VT arrest. However, for all the reasons mentioned, we still recommend CPR until there is more evidence, guidance, and perhaps eventually a change in standards.