Should Anything Else be done Besides Prehospital Cardiopulmonary Resuscitation (CPR)? The Role of CPR and Prehospital Interventions After Traumatic Cardiac Arrest.

Background: Cardiopulmonary resuscitation (CPR) following traumatic cardiac arrest (TCA) has been found to have limited effectiveness in the prehospital setting. While emergency medical services (EMS) initiated CPR following TCA is a common practice, variability exists due to differences in EMS perceived futility and survivability. These perceived differences have prevented the universal implementation of CPR following TCA. We hypothesized that some trauma patients may benefit from prehospital CPR following TCA.

Objectives: We sought to identify factors associated with survival in TCA patients.

Methods: Retrospective cohort study of adult patients transported to our trauma center, after receiving CPR at the scene or in transit, from January 1, 2014 to December 31, 2022. We compared patients who arrived at the ED with and without a pulse following CPR for TCA. Multivariate logistic regression identified interventions independently associated with having a pulse on ED arrival.

Results: 244 patients met inclusion criteria. 30% of patients had a pulse on ED arrival. No differences existed for age (41 vs. 40, p = 0.44), ISS (33 vs. 36, p = 0.20), air transport (13% vs. 19%, p = 0.14), male gender (81% vs. 77%, p = 0.51), or transport time (11 min vs. 15 min, p = 0.16). Differences existed for blunt mechanism (76% vs. 63%, p = 0.04), rates of prehospital thoracostomy (39% vs. 55%, p = 0.02), tourniquet (1% vs. 8%, p = 0.045), and defibrillation (17% vs. 7%, 0.02). Patients who arrived with a pulse had a 65% mortality. On multivariate logistic regression penetrating trauma and prehospital thoracostomy were independently associated with an increased likelihood of having a pulse on arrival.

Conclusion: Patients who arrive to the ED with a pulse after prehospital CPR for TCA have a 35% chance of survival. Penetrating trauma and prehospital thoracostomy were independently associated with pulse on arrival, possibly indicating relief of tension pneumothorax.