Epidemiology of prehospital traumatic cardiac arrest in Geneva: a retrospective cohort study

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BACKGROUND: Traumatic cardiac arrest (TCA) has traditionally been seen as a non-survivable event. Advances in prehospital resuscitation have improved outcomes, and current guidelines emphasize addressing reversible causes of TCA, namely hypovolemia, hypoxemia, tension pneumothorax and tamponade. Understanding data on the causes and outcomes of TCA in a dense urban area may help improve treatment and prevention. METHODS: We conducted a retrospective cohort study of all patients who experienced a prehospital TCA in Geneva from January 1st, 2008, to December 31st, 2022. Data was extracted from the databases of the prehospital physician-led emergency service (SMUR) and the forensic medicine service. RESULTS: During the 15-year period, a total of 673 TCA cases were identified, of which 464 (68.9%) patients were managed by the SMUR. The average age was 52 ± 22 years, with 72.1% of males. In 90.5% of cases, the TCA occurred before the arrival of the SMUR, although emergency response times were short (8.7 min ± 4.4). 216 (46.5%) patients underwent resuscitation. Of these patients, return of spontaneous circulation (ROSC) was achieved in 71 (32.9%) and 62 patients (28.7%) survived to hospital admission. 8 patients (6 blunt, 2 penetrating) were alive at 30 days (3.7%). Pediatric TCA (< 18 years old) was rare, representing only 21 (3.1%) cases. CONCLUSION: Between 2008 and 2022, over 44 TCA cases per year were recorded in Geneva. Despite rapid emergency response times and ROSC achieved in more than one-third of patients who underwent resuscitation efforts, survival at 30 days was low. Factors associated with ROSC were crystalloid administration, timing of TCA, mechanism of injury, initial rhythm and the presence of an upper airway obstruction. This data underscores the need for the development and implementation of targeted interventions to enhance clinical outcomes and reduce preventable deaths within this specific patient population. TRIAL REGISTRATION: This trial was approved by the regional research ethics committee, the Commission Cantonale d'Ethique de la Recherche sur l'être humain (CCER). (Project-ID: 2023 - 00767).

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