Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 4/2022

Open Access 25-03-2022 | Original Article

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Authors: Niek Johannes Vianen, Esther Maria Maartje Van Lieshout, Iscander Michael Maissan, Wichor Matthijs Bramer, Dennis Den Hartog, Michael Herman Jacob Verhofstad, Mark Gerrit Van Vledder

Published in: European Journal of Trauma and Emergency Surgery | Issue 4/2022

Login to get access

Abstract

Background

Circulatory arrest after trauma is a life-threatening situation that mandates urgent action. The aims of this systematic review and meta-analysis on prehospital traumatic cardiac arrest (TCA) were to provide an updated pooled mortality rate for prehospital TCA, to investigate the impact of the time of patient inclusion and the type of prehospital trauma system on TCA mortality rates and neurological outcome, and to investigate which pre- and intra-arrest factors are prognostic for prehospital TCA mortality.

Methods

This review was conducted in accordance with the PRISMA and CHARMS guidelines. Databases were searched for primary studies published about prehospital TCA patients (1995–2020). Studies were divided into various EMS-system categories. Data were analyzed using MedCalc, Review Manager, Microsoft Excel, and Shinyapps Meta Power Calculator software.

Results

Thirty-six studies involving 51.722 patients were included. Overall mortality for TCA was 96.2% and a favorable neurological outcome was seen in 43.5% of the survivors. Mortality rates were 97.2% in studies including prehospital deaths and 92.3% in studies excluding prehospital deaths. Favorable neurological outcome rates were 35.8% in studies including prehospital deaths and 49.5% in studies excluding prehospital deaths. Mortality rates were 97.6% if no physician was available at the prehospital scene and 93.9% if a physician was available. Favorable neurological outcome rates were 57.0% if a physician was available on scene and 38.0% if no physician was available. Only non-shockable rhythm was associated with a higher mortality (RR 1.12, p = 0.06).

Conclusion

Approximately 1 in 20 patients with prehospital TCA will survive; about 40% of survivors have favorable neurological outcome.
Appendix
Available only for authorised users
Literature
1.
Beck B, et al. Trends in traumatic out-of-hospital cardiac arrest in Perth, Western Australia from 1997 to 2014. Resuscitation. 2016;98:79–84.PubMedCrossRef
2.
Grasner JT, et al. Cardiopulmonary resuscitation traumatic cardiac arrest—there are survivors. An analysis of two national emergency registries. Crit Care. 2011;15(6):276.CrossRef
3.
Lockey D, Crewdson K, Davies G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med. 2006;48(3):240–4.PubMedCrossRef
4.
Zwingmann J, et al. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care. 2012;16(4):R117.PubMedPubMedCentralCrossRef
5.
Tran A, et al. Pre-arrest and intra-arrest prognostic factors associated with survival following traumatic out-of-hospital cardiac arrest—a systematic review and meta-analysis. Resuscitation. 2020;153:119–35.PubMedCrossRef
6.
Di Bartolomeo S, et al. HEMS vs ground-BLS care in traumatic cardiac arrest. Prehosp Emerg Care. 2005;9(1):79–84.PubMedCrossRef
7.
Moher D, et al. Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement. Int J Surg. 2010;8(5):336–41.PubMedCrossRef
8.
9.
Bramer WM, et al. A systematic approach to searching: an efficient and complete method to develop literature searches. J Med Libr Assoc. 2018;106(4):531–41.PubMedPubMedCentral
10.
11.
12.
13.
14.
Brain Resuscitation Clinical Trial, I.S.G. Randomized clinical study of thiopental loading in comatose survivors of cardiac arrest. N Engl J Med. 1986;314(7):397–403.CrossRef
15.
Suurmond R, van Rhee H, Hak T. Introduction, comparison, and validation of meta-essentials: a free and simple tool for meta-analysis. Res Synth Methods. 2017;8(4):537–53.PubMedPubMedCentralCrossRef
16.
Stockinger ZT, McSwain NE Jr. Additional evidence in support of withholding or terminating cardiopulmonary resuscitation for trauma patients in the field. J Am Coll Surg. 2004;198(2):227–31.PubMedCrossRef
17.
Pickens JJ, Copass MK, Bulger EM. Trauma patients receiving CPR: predictors of survival. J Trauma. 2005;58(5):951–8.PubMedCrossRef
18.
Willis CD, et al. Cardiopulmonary resuscitation after traumatic cardiac arrest is not always futile. Injury. 2006;37(5):448–54.PubMedCrossRef
19.
David JS, et al. Does the prognosis of cardiac arrest differ in trauma patients? Crit Care Med. 2007;35(10):2251–5.PubMedCrossRef
20.
Huber-Wagner S, et al. Outcome in 757 severely injured patients with traumatic cardiorespiratory arrest. Resuscitation. 2007;75(2):276–85.PubMedCrossRef
21.
Faucher A, et al. Optimize the resuscitation of prehospital cardiac arrest in trauma patients: a prospective register’s experience. Ann Fr Anesth Reanim. 2009;28(5):442–7.PubMedCrossRef
22.
Moriwaki Y, et al. Outcomes from prehospital cardiac arrest in blunt trauma patients. World J Surg. 2011;35(1):34–42.PubMedCrossRef
23.
Cureton EL, et al. The heart of the matter: utility of ultrasound of cardiac activity during traumatic arrest. J Trauma Acute Care Surg. 2012;73(1):102–10.PubMedCrossRef
24.
Deasy C, et al. Traumatic out-of-hospital cardiac arrests in Melbourne, Australia. Resuscitation. 2012;83(4):465–70.PubMedCrossRef
25.
Lin CH, et al. Use of automated external defibrillators in patients with traumatic out-of-hospital cardiac arrest. Resuscitation. 2013;84(5):586–91.PubMedCrossRef
26.
Kitamura T, et al. Epidemiology and outcome of adult out-of-hospital cardiac arrest of non-cardiac origin in Osaka: a population-based study. BMJ Open. 2014;4(12):e006462.PubMedPubMedCentralCrossRef
27.
Evans CC, et al. Prehospital traumatic cardiac arrest: Management and outcomes from the resuscitation outcomes consortium Epistry-Trauma and PROPHET registries. J Trauma Acute Care Surg. 2016;81(2):285–93.PubMedPubMedCentralCrossRef
28.
Barnard E, et al. Epidemiology and aetiology of traumatic cardiac arrest in England and Wales—a retrospective database analysis. Resuscitation. 2017;110:90–4.PubMedCrossRef
29.
Beck B, et al. Predicting outcomes in traumatic out-of-hospital cardiac arrest: the relevance of Utstein factors. Emerg Med J. 2017;34(12):786–92.PubMedCrossRef
30.
Chia MY, et al. Characteristics and outcomes of young adults who suffered an out-of-hospital cardiac arrest (OHCA). Resuscitation. 2017;111:34–40.PubMedCrossRef
31.
Chiang WC, et al. Performance of a simplified termination of resuscitation rule for adult traumatic cardiopulmonary arrest in the prehospital setting. Emerg Med J. 2017;34(1):39–45.PubMedCrossRef
32.
Claesson A, et al. Medical versus non-medical etiology in out-of-hospital cardiac arrest—changes in outcome in relation to the revised Utstein template. Resuscitation. 2017;110:48–55.PubMedCrossRef
33.
Duchateau FX, et al. Long-term prognosis after out-of-hospital resuscitation of cardiac arrest in trauma patients: prehospital trauma-associated cardiac arrest. Emerg Med J. 2017;34(1):34–8.PubMedCrossRef
34.
Irfan FB, et al. Cardiopulmonary resuscitation of out-of-hospital traumatic cardiac arrest in Qatar: a nationwide population-based study. Int J Cardiol. 2017;240:438–43.PubMedCrossRef
35.
Djarv T, et al. Traumatic cardiac arrest in Sweden 1990–2016—a population-based national cohort study. Scand J Trauma Resusc Emerg Med. 2018;26(1):30.PubMedPubMedCentralCrossRef
36.
Escutnaire J, et al. Traumatic cardiac arrest is associated with lower survival rate vs medical cardiac arrest—results from the French national registry. Resuscitation. 2018;131:48–54.PubMedCrossRef
37.
Fukuda T, et al. Association of prehospital advanced life support by physician with survival after out-of-hospital cardiac arrest with blunt trauma following traffic collisions: Japanese registry-based study. JAMA Surg. 2018;153(6):e180674.PubMedPubMedCentralCrossRef
38.
Tsutsumi Y, et al. Association between spinal immobilization and survival at discharge for on-scene blunt traumatic cardiac arrest: a nationwide retrospective cohort study. Injury. 2018;49(1):124–9.PubMedCrossRef
39.
Aoki M, Abe T, Oshima K. Association of prehospital epinephrine administration with survival among patients with traumatic cardiac arrest caused by traffic collisions. Sci Rep. 2019;9(1):9922.PubMedPubMedCentralCrossRef
40.
Barnard EBG, et al. Prehospital determinants of successful resuscitation after traumatic and non-traumatic out-of-hospital cardiac arrest. Emerg Med J. 2019;36(6):333–9.PubMedCrossRef
41.
Chen YC, et al. Factors associated with outcomes in traumatic cardiac arrest patients without prehospital return of spontaneous circulation. Injury. 2019;50(1):4–9.PubMedCrossRef
42.
Israr S, et al. Pulseless electrical activity following traumatic cardiac arrest: sign of life or death? Injury. 2019;50(9):1507–10.PubMedCrossRef
43.
Lu CH, Fang PH, Lin CH. Dispatcher-assisted cardiopulmonary resuscitation for traumatic patients with out-of-hospital cardiac arrest. Scand J Trauma Resusc Emerg Med. 2019;27(1):97.PubMedPubMedCentralCrossRef
44.
Ter Avest E, et al. Out-of-hospital cardiac arrest following trauma: What does a helicopter emergency medical service offer? Resuscitation. 2019;135:73–9.PubMedCrossRef
45.
Yamamoto R, et al. Epinephrine during resuscitation of traumatic cardiac arrest and increased mortality: a post hoc analysis of prospective observational study. Scand J Trauma Resusc Emerg Med. 2019;27(1):74.PubMedPubMedCentralCrossRef
46.
Javaudin F, et al. Maximum value of end-tidal carbon dioxide concentrations during resuscitation as an indicator of return of spontaneous circulation in out-of-hospital cardiac arrest. Prehosp Emerg Care. 2020;24(4):478–84.PubMedCrossRef
47.
Jun GS, et al. Prognostic factors related with outcomes in traumatic out-of-hospital cardiac arrest patients without prehospital return of spontaneous circulation: a nationwide observational study. Clin Exp Emerg Med. 2020;7(1):14–20.PubMedPubMedCentralCrossRef
48.
Houwen T, et al. Outcomes after prehospital traumatic cardiac arrest in the Netherlands: a retrospective cohort study. Injury. 2021;52(5):1117–22.PubMedCrossRef
49.
van Waes OJF, et al. Evaluation of out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma; three years after our first report. Injury. 2019;50(11):2136–7.PubMedCrossRef
50.
Van Vledder MG, et al. Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma. Injury. 2017;48(9):1865–9.PubMedCrossRef
51.
Peters J, et al. Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service. Eur J Emerg Med. 2017;24(2):96–100.PubMedCrossRef
52.
Perkins GD, et al. Cardiac arrest and cardiopulmonary resuscitation outcome reports: update of the Utstein resuscitation registry templates for out-of-hospital cardiac arrest: a statement for healthcare professionals from a Task Force of the International Liaison Committee on Resuscitation (American Heart Association, European Resuscitation Council, Australian and New Zealand Council on Resuscitation, Heart and Stroke Foundation of Canada, InterAmerican Heart Foundation, Resuscitation Council of Southern Africa, Resuscitation Council of Asia); and the American Heart Association Emergency Cardiovascular Care Committee and the Council on Cardiopulmonary, Critical Care, Perioperative and Resuscitation. Resuscitation. 2015;96:328–40.PubMedCrossRef
Metadata
Title
Prehospital traumatic cardiac arrest: a systematic review and meta-analysis
Authors
Niek Johannes Vianen
Esther Maria Maartje Van Lieshout
Iscander Michael Maissan
Wichor Matthijs Bramer
Dennis Den Hartog
Michael Herman Jacob Verhofstad
Mark Gerrit Van Vledder
Publication date
25-03-2022
Publisher
Springer Berlin Heidelberg
Published in
European Journal of Trauma and Emergency Surgery / Issue 4/2022
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-022-01941-y

Other articles of this Issue 4/2022

European Journal of Trauma and Emergency Surgery 4/2022 Go to the issue

Original Article

Predictors for wound healing complications and prolonged hospital stay in patients with isolated calcaneal fractures

Original Article

Operative treatment of fragility fractures of the pelvis: a critical analysis of 140 patients

Review Article

Precision medicine in trauma: a transformational frontier in patient care, education, and research

Original Article

Influence of anaemia in severely injured patients on mortality, transfusion and length of stay: an analysis of the TraumaRegister DGU®

Original Article

Comparison of CATCH, PECARN, and CHALICE clinical decision rules in pediatric patients with mild head trauma

Original Article

Incidence and risk factors of preoperative deep venous thrombosis following hip fracture: a retrospective analysis of 293 consecutive patients