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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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.

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