Many of us have looked at the dying trauma patient and wondered: why can’t we do better? The pathology is often deceptively simple—either there’s not enough circulating blood volume or a mechanical obstruction is preventing perfusion. Frequently, this is a young, previously healthy patient whose life has suddenly unraveled. Yet despite our current mantra of hypovolemia correction, decompression of obstruction and hemostasis, meaningful survival from traumatic cardiac arrest is so rare that the abysmal outcomes of medical cardiac arrest almost seem preferable.