Traumatic cardiac arrest (TCA) has seen a paradigm shift in treatment, moving from a belief in futility to a more optimistic perspective, especially in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat potentially reversible causes, such as hypovolemia, oxygenation impairment, tension pneumothorax, and pericardial tamponade. Advances in diagnostics and therapy continue, but outcomes are not always improved. Further research is needed to enhance outcomes in this often young and previously healthy population. TCA is commonly caused by trauma, with hypovolemia being the most frequent reversible cause. Other causes include oxygenation issues, tension pneumothorax, and cardiac tamponade. The H.O.T.T. acronym (Hypovolemia, Oxygenation, Tension pneumothorax, Tamponade) helps guide treatment. TCA outcomes vary widely, with survival rates ranging from 4% to 40%. Factors such as younger age, female sex, and shockable rhythms are associated with better outcomes. Diagnosing TCA can be challenging, with pseudo PEA (a state of severe hypotension with no detectable pulse) potentially mistaken for true PEA. POCUS (point-of-care ultrasound) is useful in identifying cardiac motion, which is associated with better survival. However, POCUS should only be used when it can change treatment. TCA treatment focuses on addressing reversible causes, with chest compressions being less effective in hypovolemic patients. Instead, interventions like resuscitative thoracotomy or controlling hemorrhage are prioritized. Cardiac rhythms in TCA include asystole and PEA, with shockable rhythms like ventricular tachycardia being rare but associated with better outcomes. Cardiac injuries, such as blunt or penetrating trauma, can cause TCA. Cardiac contusions and electrotrauma-induced arrests are also possible causes. TCA management requires a multidisciplinary approach, with POCUS playing a key role in diagnosing and treating reversible causes. Guidelines for TCA emphasize the importance of addressing reversible causes, with a shift from traditional ABCD (Airway, Breathing, Circulation, Disability) to a more focused approach. Adrenaline use in TCA is controversial, with some studies suggesting it may not be beneficial. Relative hypovolemia, caused by blood redistribution, can also contribute to TCA, particularly in spinal injuries. In conclusion, TCA treatment has evolved to focus on rapid intervention for reversible causes, with ongoing research needed to improve outcomes. The role of POCUS and specialized interventions like resuscitative thoracotomy is critical in managing TCA effectively.Traumatic cardiac arrest (TCA) has seen a paradigm shift in treatment, moving from a belief in futility to a more optimistic perspective, especially in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat potentially reversible causes, such as hypovolemia, oxygenation impairment, tension pneumothorax, and pericardial tamponade. Advances in diagnostics and therapy continue, but outcomes are not always improved. Further research is needed to enhance outcomes in this often young and previously healthy population. TCA is commonly caused by trauma, with hypovolemia being the most frequent reversible cause. Other causes include oxygenation issues, tension pneumothorax, and cardiac tamponade. The H.O.T.T. acronym (Hypovolemia, Oxygenation, Tension pneumothorax, Tamponade) helps guide treatment. TCA outcomes vary widely, with survival rates ranging from 4% to 40%. Factors such as younger age, female sex, and shockable rhythms are associated with better outcomes. Diagnosing TCA can be challenging, with pseudo PEA (a state of severe hypotension with no detectable pulse) potentially mistaken for true PEA. POCUS (point-of-care ultrasound) is useful in identifying cardiac motion, which is associated with better survival. However, POCUS should only be used when it can change treatment. TCA treatment focuses on addressing reversible causes, with chest compressions being less effective in hypovolemic patients. Instead, interventions like resuscitative thoracotomy or controlling hemorrhage are prioritized. Cardiac rhythms in TCA include asystole and PEA, with shockable rhythms like ventricular tachycardia being rare but associated with better outcomes. Cardiac injuries, such as blunt or penetrating trauma, can cause TCA. Cardiac contusions and electrotrauma-induced arrests are also possible causes. TCA management requires a multidisciplinary approach, with POCUS playing a key role in diagnosing and treating reversible causes. Guidelines for TCA emphasize the importance of addressing reversible causes, with a shift from traditional ABCD (Airway, Breathing, Circulation, Disability) to a more focused approach. Adrenaline use in TCA is controversial, with some studies suggesting it may not be beneficial. Relative hypovolemia, caused by blood redistribution, can also contribute to TCA, particularly in spinal injuries. In conclusion, TCA treatment has evolved to focus on rapid intervention for reversible causes, with ongoing research needed to improve outcomes. The role of POCUS and specialized interventions like resuscitative thoracotomy is critical in managing TCA effectively.