Seo Dongmin, Heo Inhae, Jung Kyoungwon, Jung Hohyung
Division of Trauma Surgery, Department of Surgery, Ajou University School of Medicine, 164 Worldcup-ro, Yeongtong-gu, Suwon-si, Gyeonggi-do, 16499, Republic of Korea.
Regional Trauma Center of Southern Gyeong-gi Province, Ajou University School of Medicine, Suwon, Republic of Korea.
BMC Emerg Med. 2025 Apr 14;25(1):61. doi: 10.1186/s12873-025-01219-7.
Despite advances in trauma care, traumatic cardiac arrest (TCA) shows significantly poorer outcomes compared to non-traumatic cardiac arrest, with mortality rates exceeding 96%. However, no standardized protocol exists for appropriate cardiopulmonary resuscitation (CPR) duration in TCA. This study aimed to establish evidence-based CPR duration thresholds and identify factors associated with return of spontaneous circulation (ROSC) in TCA patients.
We conducted a retrospective observational study using a single-centre trauma registry of adult patients with TCA between January 2021 and December 2023. Univariate analysis was used to identify differences in the baseline and outcome variables between the ROSC and no-ROSC groups. We performed multivariable logistic regression analysis to identify factors independently associated with ROSC. We also investigated the appropriate cutoff time of pre-hospital and total CPR duration for ROSC (the CPR duration that has maximum sensitivity and specificity for ROSC).
In total, 422 patients with TCA were included, of whom 250 were eligible for analysis. The proportion of patients with ROSC was 22.4% (n = 56), and trauma bay/emergency department mortality and in-hospital mortality rates were 80.8% (n = 202) and 97.2% (n = 243), respectively. Factors associated with ROSC included alert mental status in the field, as indicated by verbal response (adjusted odds ratio [OR], 0.07; 95% confidence interval [CI], 0.01-1.12; p = 0.06), pain response (OR, 0.03; 95% CI, 0.01-0.43; p = 0.009), and unresponsiveness (OR, 0.04; 95% CI, 0.01-0.44; p = 0.009) and non-asystolic initial rhythms, such as pulseless electrical activity (OR, 4.26; 95% CI, 1.92-9.46; p < 0.001), shockable rhythm (OR, 14.26; 95% CI, 1.44-141.54; p = 0.023), pre-hospital CPR duration (OR, 0.90; 95% CI, 0.85-0.95), and total CPR duration (OR, 0.88; 95% CI, 0.84-0.92; p < 0.001). The upper limits of pre-hospital and total CPR durations for achieving a probability of ROSC < 1% were 23 and 30 min, respectively, whereas those for a cumulative portion of ROSC > 99% were 27 and 38 min, respectively. Among the survivors (n = 7), six had favourable functional outcomes at discharge.
This study provides evidence-based CPR duration thresholds in TCA, demonstrating that resuscitation efforts beyond 27 min in prehospital settings and 38 min in total were futile. Additionally, an alert mental status in the field and non-asystolic initial rhythm were identified as positive predictors of ROSC. These findings may help guide appropriate duration of resuscitation efforts in TCA.
尽管创伤护理有所进步，但与非创伤性心脏骤停相比，创伤性心脏骤停（TCA）的预后明显更差，死亡率超过96%。然而，目前尚无针对TCA患者进行适当心肺复苏（CPR）时长的标准化方案。本研究旨在确定基于证据的CPR时长阈值，并识别与TCA患者自主循环恢复（ROSC）相关的因素。
我们使用一个单中心创伤登记系统，对2021年1月至2023年12月期间成年TCA患者进行了一项回顾性观察研究。采用单因素分析来识别ROSC组和无ROSC组之间基线和结局变量的差异。我们进行多变量逻辑回归分析以识别与ROSC独立相关的因素。我们还研究了实现ROSC的院前和总CPR时长的合适截断时间（对ROSC具有最大敏感性和特异性的CPR时长）。
总共纳入了422例TCA患者，其中250例符合分析条件。ROSC患者的比例为22.4%（n = 56），创伤室/急诊科死亡率和住院死亡率分别为80.8%（n = 202）和97.2%（n = 243）。与ROSC相关的因素包括现场清醒的精神状态，通过言语反应体现（调整后的优势比[OR]，0.07；95%置信区间[CI]，0.01 - 1.12；p = 0.06）、疼痛反应（OR，0.03；95% CI，0.01 - 0.43；p = 0.009）和无反应性（OR，0.04；95% CI，0.01 - 0.44；p = 0.009），以及非心搏停止的初始心律，如无脉电活动（OR，4.26；95% CI，1.92 - 9.46；p < 0.001）、可电击心律（OR，14.26；95% CI，1.44 - 141.54；p = 0.023）、院前CPR时长（OR，0.90；95% CI，0.85 - 0.95）和总CPR时长（OR，0.88；95% CI，0.84 - 0.92；p < 0.001）。实现ROSC概率 < 1%的院前和总CPR时长上限分别为23分钟和30分钟，而ROSC累积比例 > 99%的则分别为27分钟和38分钟。在幸存者（n = 7）中，6例出院时功能结局良好。
本研究提供了基于证据的TCA患者CPR时长阈值，表明院前超过27分钟和总计超过38分钟的复苏努力是徒劳的。此外，现场清醒的精神状态和非心搏停止的初始心律被确定为ROSC的阳性预测因素。这些发现可能有助于指导TCA患者适当的复苏时长。
