CPR was initially developed to try to maintain perfusion and oxygenation in a casualty with normal blood volume who was in cardiac arrest until defibrillation and advanced cardiac life support measures could be instituted. It was never envisioned as a viable treatment for cardiac arrest due to traumatic hypovolemia.

In fact, in civilian prehospital settings, even when a casualty is close to a trauma center, studies have repeatedly emphasized the futility of CPR. Most Emergency Medical Systems and professional societies recommended that CPR not be attempted for casualties who suffer a prehospital traumatic cardiac arrest, citing the large economic costs and the uniformly unsuccessful results. Even in casualties who arrived quickly at a hospital emergency room with a trauma team and underwent a thoracostomy, the survival rate was less than 2%.

On the battlefield, the delay in getting the casualty to definitive care makes it even less likely that a favorable outcome could be achieved. Dedicating limited resources to resuscitation attempts, or exposing responders to hostile fire while performing CPR, also compounds the situation and risks adversely affecting the outcome of other casualties. This further supports the decision to withhold CPR for casualties on the battlefield.

TCCC Guidelines state: “Resuscitation on the battlefield for victims of blast or penetrating trauma who have no pulse, no ventilations, and no other signs of life will not be successful and should not be attempted.”