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Background <p> <?tk 4?>The evidence to support guideline-recommended interventions in traumatic cardiac arrest (TCA) is low.</p> Methods <p> <?tk 4?>This multicentre, retrospective study included 996 paediatric and adult patients with out-of-hospital TCA (01/2010-12/2019). Demographic, clinical, and pre-hospital data, binary delivery of five core interventions, and outcomes were collected. Crude (crosstabs) and adjusted (logistic regressions) odds ratios (OR) with 95% confidence intervals (95%CI) were calculated to determine the associations between single interventions and outcomes.</p> Results <p> <?tk 4?>A sustained return-of-spontaneous-circulation (ROSC) was achieved in 341 subjects (34.2%). The 30-day and 1-year survival rates were 7.4 and 6.6%, respectively. The 95%CIs of the crude ORs for sustained ROSC were greater than one for all interventions. The 95%CIs of the crude ORs for 30-day and 1-year survival were greater than one for fluid infusion (20.5, 5.0-84.4), pelvic binder application (11.2, 3.3–37.7), as well as airway protection and ventilation with 100% oxygen (3.7, 1.5–9.5), but not for epinephrine use (1.4, 0.8–2.5) or bilateral chest decompression (1.0, 0.5-2.0). The 95%CIs of the adjusted ORs of fluid infusion (7.8, 4.7–13.5), application of a pelvic binder (8.9, 1.3–17.6), airway protection and ventilation with 100% oxygen (4.5, 2.5–8.7), as well as epinephrine use (4.0, 2.6–6.2) were greater than one for sustained ROSC. For 30-day and 1-year survival, the 95%CIs of the adjusted odds ratios of fluid infusion (30-day: 19.9, 4.1–359; 1-year: 16.8, 3.4–305) and pelvic binder application (30-day: 14.4, 2.3–90.8; 1-year: 19.8, 3.1–127), but not airway protection and ventilation with 100% oxygen (30-day: 1.9, 0.7–6.6; 1-year: 1.4, 0.5–5.1), epinephrine use (30-day: 1.0, 0.5–2.1; 1-year: 0.7, 0.3–1.5) or bilateral chest decompression (30-day: 1.1, 0.4–2.8; 1-year: 1.5, 0.6–3.9) were greater than one. The number of interventions correlated with the rates of sustained ROSC (<i>Φ</i> = 0.405; <i>p</i> &lt; 0.001), 30-day (<i>Φ</i> = 0.168; <i>p</i> &lt; 0.001), and 1-year (<i>Φ</i> = 0.169; <i>p</i> &lt; 0.001) survival.</p> Conclusions <p> <?tk 4?>Our results suggest that fluid infusion, application of a pelvic binder, as well as airway protection and ventilation with 100% oxygen in TCA are associated with higher rates of sustained ROSC, 30-day and 1-year survival. A bundled approach of these interventions might be beneficial. The high 30-day and 1-year survival rates underscore the value and effectiveness of resuscitation efforts in TCA patients.</p>

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Associations between four standard interventions as well as epinephrine use and sustained ROSC, 30-Day and one-year survival of patients in traumatic cardiac arrest: a multicentre, retrospective cohort study

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  • 发表日期：

    2025年10月14日

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  • Romana Erblich,
  • Jens Meier,
  • Tina Tomic Mahecic,
  • Matthias Noitz,
  • Stephan Kalb,
  • Helmut Trimmel,
  • Julian M. Baumkirchner,
  • Maximilian Havlicek,
  • Wolfgang Voelckel,
  • Luca Carenzo,
  • Martin W. Dünser

摘要

Background

The evidence to support guideline-recommended interventions in traumatic cardiac arrest (TCA) is low.

Methods

This multicentre, retrospective study included 996 paediatric and adult patients with out-of-hospital TCA (01/2010-12/2019). Demographic, clinical, and pre-hospital data, binary delivery of five core interventions, and outcomes were collected. Crude (crosstabs) and adjusted (logistic regressions) odds ratios (OR) with 95% confidence intervals (95%CI) were calculated to determine the associations between single interventions and outcomes.

Results

A sustained return-of-spontaneous-circulation (ROSC) was achieved in 341 subjects (34.2%). The 30-day and 1-year survival rates were 7.4 and 6.6%, respectively. The 95%CIs of the crude ORs for sustained ROSC were greater than one for all interventions. The 95%CIs of the crude ORs for 30-day and 1-year survival were greater than one for fluid infusion (20.5, 5.0-84.4), pelvic binder application (11.2, 3.3–37.7), as well as airway protection and ventilation with 100% oxygen (3.7, 1.5–9.5), but not for epinephrine use (1.4, 0.8–2.5) or bilateral chest decompression (1.0, 0.5-2.0). The 95%CIs of the adjusted ORs of fluid infusion (7.8, 4.7–13.5), application of a pelvic binder (8.9, 1.3–17.6), airway protection and ventilation with 100% oxygen (4.5, 2.5–8.7), as well as epinephrine use (4.0, 2.6–6.2) were greater than one for sustained ROSC. For 30-day and 1-year survival, the 95%CIs of the adjusted odds ratios of fluid infusion (30-day: 19.9, 4.1–359; 1-year: 16.8, 3.4–305) and pelvic binder application (30-day: 14.4, 2.3–90.8; 1-year: 19.8, 3.1–127), but not airway protection and ventilation with 100% oxygen (30-day: 1.9, 0.7–6.6; 1-year: 1.4, 0.5–5.1), epinephrine use (30-day: 1.0, 0.5–2.1; 1-year: 0.7, 0.3–1.5) or bilateral chest decompression (30-day: 1.1, 0.4–2.8; 1-year: 1.5, 0.6–3.9) were greater than one. The number of interventions correlated with the rates of sustained ROSC (Φ = 0.405; p < 0.001), 30-day (Φ = 0.168; p < 0.001), and 1-year (Φ = 0.169; p < 0.001) survival.

Conclusions

Our results suggest that fluid infusion, application of a pelvic binder, as well as airway protection and ventilation with 100% oxygen in TCA are associated with higher rates of sustained ROSC, 30-day and 1-year survival. A bundled approach of these interventions might be beneficial. The high 30-day and 1-year survival rates underscore the value and effectiveness of resuscitation efforts in TCA patients.