Cheng Han, Chiu Po-Wei, Lin Chih-Hao
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Department of Emergency Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
Injury. 2025 May;56(5):112262. doi: 10.1016/j.injury.2025.112262. Epub 2025 Mar 13.
Traumatic cardiac arrest (TCA) is associated with poor prognosis. Recent advancements in resuscitation techniques have improved outcomes; however, the prognostic value of the initial cardiac rhythm in TCA remains unclear. Pulseless electrical activity (PEA) is often a sign of life, leading to ongoing resuscitation efforts; however, its effect on survival remains controversial. This study aimed to clarify the prognostic impact of PEA and asystole in patients with TCA to inform decision-making.
This retrospective cohort study was conducted in a tertiary trauma center in Tainan, Taiwan, between 2016 and 2022 and enrolled patients with TCA transported by emergency medical services. Exclusion criteria included patients aged < 18 years with prehospital return of spontaneous circulation (ROSC) or specific trauma etiologies. Only non-shockable rhythms (PEA and asystole) were analyzed. Data on patient characteristics, trauma mechanisms, and resuscitation interventions were collected from electronic medical records. The primary outcome was ROSC at any time after reaching hospital, with secondary outcomes including sustained ROSC (ROSC for over 20 min), survival to admission, survival to discharge, and the cerebral performance category scale. Statistical analyzes were performed using the chi-square test and multivariate logistic regression. Statistical significance was defined as p < 0.05.
Of the 2,029 out-of-hospital cardiac arrest cases, 182 were TCA, and 46 were excluded based on various criteria. The final analysis included 136 patients divided into the PEA (n = 78, 57 %) and asystole (n = 58, 43 %) groups. No significant differences were observed in patient demographics, clinical characteristics, or resuscitative interventions between the groups. The PEA group had a significantly higher rate of ROSC (49 % vs. 26 %, p = 0.007), although survival to discharge remained low. Multivariable analysis revealed that PEA was the only factor significantly associated with ROSC (odds ratio: 2.87, p = 0.007).
In patients with TCA presenting with non-shockable rhythms, PEA was significantly associated with achieving ROSC, but not sustained ROSC or survival to admission. As a subset of patients in the PEA group survived until discharge, the existing guidelines for termination of resuscitation in TCA cases may require further evaluation.
创伤性心脏骤停（TCA）预后较差。复苏技术的最新进展改善了预后；然而，TCA初始心律的预后价值仍不明确。无脉电活动（PEA）通常是有生命迹象，会导致持续的复苏努力；然而，其对生存的影响仍存在争议。本研究旨在阐明PEA和心脏停搏对TCA患者的预后影响，以指导决策。
本回顾性队列研究于2016年至2022年在台湾台南的一家三级创伤中心进行，纳入由紧急医疗服务转运的TCA患者。排除标准包括年龄<18岁且院外恢复自主循环（ROSC）或有特定创伤病因的患者。仅分析不可电击心律（PEA和心脏停搏）。从电子病历中收集患者特征、创伤机制和复苏干预的数据。主要结局是入院后任何时间的ROSC，次要结局包括持续ROSC（ROSC超过20分钟）、入院存活、出院存活以及脑功能分类量表。使用卡方检验和多变量逻辑回归进行统计分析。统计学显著性定义为p<0.05。
在2029例院外心脏骤停病例中，182例为TCA，46例根据各种标准被排除。最终分析纳入136例患者，分为PEA组（n = 78，57%）和心脏停搏组（n = 58，43%）。两组患者的人口统计学、临床特征或复苏干预方面未观察到显著差异。PEA组的ROSC率显著更高（49%对26%，p = 0.007），尽管出院存活率仍然较低。多变量分析显示，PEA是与ROSC显著相关的唯一因素（比值比：2.87，p = 0.007）。
在表现为不可电击心律的TCA患者中，PEA与实现ROSC显著相关，但与持续ROSC或入院存活无关。由于PEA组中的一部分患者存活至出院，TCA病例中现有复苏终止指南可能需要进一步评估。
