Timing and outcomes of out-of-hospital traumatic cardiac arrest: results of a multicentre, retrospective cohort study.
Resuscitation plus · 2026-06-26 · Observational study
Abstract
BACKGROUND: Out-of-hospital traumatic cardiac arrest (TCA) is associated with high mortality. Outcomes may depend on the timing of TCA onset. This study aimed to characterize the timing of out-of-hospital TCA and its association with patient outcomes. METHODS: In this multicentre, retrospective, observational study, patients with out-of-hospital TCA attended by a nationwide helicopter emergency medical service (HEMS) were included. TCA timing was stratified into three prehospital intervals: on scene before arrival of the first emergency medical service (EMS) unit, on scene after EMS arrival, and during HEMS transport. Primary outcomes were proportions of TCA across time intervals. Secondary outcomes included sustained return of spontaneous circulation (ROSC), 30-day survival, and 1-year survival in patients without criteria to withhold resuscitation. Multivariable regression was used to identify predictors of sustained ROSC and 1-year survival among patients sustaining TCA before EMS arrival. RESULTS: Among 1532 patients, 90.2% sustained TCA before EMS arrival, 8.2% after EMS arrival, and 1.6% during HEMS transport. Sustained ROSC occurred in 20.8%, 47.2%, and 92.0% of patients, respectively (p < 0.001). One-year survival was 3.5%, 10.0%, and 15.0% (p < 0.001), respectively. In patients with TCA before EMS arrival, an initial electrocardiographic rhythm other than asystole was the only independent predictor of sustained ROSC and 1-year survival. CONCLUSION: Nine out of ten out-of-hospital TCAs occur before EMS arrival. Timing of out-of-hospital TCA is associated with resuscitation success and survival. Meaningful survival rates are, however, achievable irrespective of TCA onset. This supports resuscitation efforts in all patients with out-of-hospital TCA and no criteria to withhold resuscitation.