TXA in traumatic cardiac arrest

Tranexamic acid (TXA) is not beneficial in traumatic cardiac arrest because its mechanism requires effective circulation and early clot stabilization, neither of which are present once cardiac arrest occurs (similarly to routine Naloxone administration in suspected opioid cardiac arrests, which is no longer advised). Major TXA trials (CRASH-2 and CRASH-3) excluded cardiac arrest patients (no survival benefit demonstrated), and traumatic cardiac arrest management prioritizes correction of reversible causes; for example, airway management, chest decompression, rapid hemorrhage control, rapid volume/blood replacement, and pelvic stabilization is recommended over antifibrinolytic therapy.

Rapid hemorrhage control and restoration of circulating volume are time‑critical interventions. TXA itself does not stop active bleeding nor does it substitute for mechanical control, blood transfusion, or surgical intervention. Administering TXA during cardiac arrest risks diverting attention and time from proven life‑saving interventions and rapid transport to definitive care.

In summary, TXA has demonstrated benefit in select trauma patients with active hemorrhage who retain spontaneous circulation, when administered within 3 hours of injury. While TXA is generally safe in select indicated trauma patients, current available evidence does not support a benefit for TXA administration once a patient has progressed to traumatic cardiac arrest. Some data even suggest increased risks of thromboembolic events and seizures in non‑beneficial settings. In the absence of demonstrated efficacy, routine use of TXA in traumatic cardiac arrest is not supported by current evidence or guidelines.