The St.Emlyn’s Podcast

Recorded at Trauma 2030 at the Royal College of Surgeons in London in December 2025, this short St Emlyn’s podcast looks at one of the most challenging situations in prehospital and emergency care: traumatic cardiac arrest.

Iain is joined by Laura Kocierz, a Consultant with London’s Air Ambulance and a Consultant in Critical Care Medicine and Anaesthesia in the Midlands.

In this conversation, Laura and Iain explore how data can help us make better decisions about resuscitative thoracotomy.

Traumatic cardiac arrest is not always a simple binary event. Patients may deteriorate through a profound low-output state before complete circulatory arrest, and recognising the underlying cause quickly is critical.

Laura discusses how the surface location of a penetrating injury can help distinguish cardiac tamponade from exsanguination. A wound within the cardiac box or epigastrium carries a substantially higher likelihood of tamponade, making immediate thoracotomy an important consideration when an organised cardiac rhythm remains.

The conversation also explores the ECG as a potential surrogate for time since traumatic cardiac arrest. Sinus rhythm, bradycardia, agonal complexes and asystole may represent progressive physiological deterioration and can add useful information when the reported timing of arrest is uncertain.

This leads to an important challenge to the traditional “15-minute rule”. If the history suggests a prolonged arrest but the patient has a penetrating injury consistent with tamponade and still has an organised rhythm, Laura explains why the physiological evidence may be more useful than an uncertain reported time.

The other key message is equally important: resuscitative thoracotomy is not a treatment for exsanguination. When major blood loss is the likely cause, priorities remain haemorrhage control, blood transfusion and rapid access to definitive care, while continuing to look actively for co-existing tamponade.

In this podcast:

• Defining traumatic cardiac arrest as a clinical and physiological state
• Using wound location to estimate the likelihood of cardiac tamponade
• The significance of penetrating injury within the cardiac box and epigastrium
• Using ECG rhythm as a clue to the duration of circulatory arrest
• Why reported arrest times may be unreliable
• Rethinking the traditional 15-minute threshold for resuscitative thoracotomy
• Distinguishing tamponade from exsanguination
• Why thoracotomy should not distract from haemorrhage control and blood transfusion
• How data from London’s Air Ambulance is helping make traumatic cardiac arrest care more targeted

A short conversation with some important practical challenges to the way we think about traumatic cardiac arrest, particularly when deciding who may genuinely benefit from resuscitative thoracotomy.

Learning from podcasts?

If podcasts form part of your CPD, you can log your listening time across all podcasts on MedPod Learn — not just St Emlyn’s — and generate structured reflection. The app is free to download, includes a one-month free trial, and offers globally adjusted pricing.

Trauma 2030

TRAUMA 2030 united experts and innovators to shape the future of trauma care. Over two days, it explored breakthroughs in science, systems, and frontline practice, fostering collaboration across disciplines. The symposium aimed to inspire research, inform policy, and build a bold roadmap for trauma care worldwide.