324 Original article

Prehospital interventions and outcomes in traumatic cardiac

arrest: a population-based cohort study using the Danish
Helicopter Emergency Medical Services data
Signe Amalie Wolthersa,b, Niklas Breindahla,b,c, Theo Walther Jensena,d,
Mathias Geldermann Holgersenb,e, Thea Palsgaard Møllera,f,
Stig Nikolaj Fasmer Blomberga, Lars Bredevang Andersena,Søren Mikkelseng,
Jacob Steinmetzh,i,j and Helle Collatz Christensena,b

Background and importance Traumatic cardiac Factors associated with an increased likelihood of ROSC
arrest is associated with poor prognosis, and timely were an initial shockable cardiac rhythm, odds ratio (OR)
evidence-based treatment is paramount for increasing of 3.78 (95% CI 1.33–11.00) and endotracheal intubation,
survival rates. Physician-staffed helicopter emergency OR 7.10 (95% CI 2.55–22.85).
medical service use in major trauma has demonstrated
Conclusion This study highlights the low survival rates
improved outcomes. However, the sparsity of
observed among patients with traumatic cardiac arrest
data highlights the necessity for a comprehensive
assessed by helicopter emergency medical services. The
understanding of the epidemiology of traumatic cardiac
findings support the positive impact of an initial shockable
arrest.
cardiac rhythm and endotracheal intubation in improving
Objectives The primary objective of the present study the likelihood of ROSC. The study contributes to the
was to evaluate survival and return of spontaneous limited literature on traumatic cardiac arrests assessed by
circulation (ROSC) and to investigate the characteristics physician-staffed helicopter emergency services. Finally,
of patients with traumatic cardiac arrest assessed by the the findings emphasise the need for further research to
Danish HEMS. understand and improve outcomes in this subgroup of
cardiac arrest. European Journal of Emergency Medicine
Design This was a population-based cohort study
31: 324–331 Copyright © 2023 The Author(s). Published
based on data from the Danish helicopter emergency
by Wolters Kluwer Health, Inc.
medical service database.
European Journal of Emergency Medicine 2024, 31:324–331
Settings and participants The study included all
patients assessed by the Danish helicopter emergency Keywords: EMS, epidemiology, HEMS, traumatic cardiac arrest

medical services between 2016 and 2021. a

Prehospital Center, Region Zealand, Næstved, bDepartment of Clinical
Medicine, University of Copenhagen, cDepartment of Neonatal and Paediatric
Outcome measures and analysis Data were Intensive Care, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
d
Department of Anaesthesiology and Intensive care Medicine, Copenhagen
analysed using descriptive statistics, non-parametric testing University Hospital, Herlev, ePaediatric Pulmonary Service, Department of
and logistic regression analyses. Descriptive analysis Paediatrics and Adolescent Medicine, Copenhagen University Hospital,
Rigshospitalet, Copenhagen, fDepartment of Anesthesiology and Intensive
of prehospital interventions included cardiopulmonary Care Medicine, Holbæk hospital, Region Zealand, gPrehospital Research Unit,
resuscitation, defibrillation, airway management, Department of Anaesthesiology and Intensive Care, Odense University Hospital,
administration of blood products, and thoracic Odense hDepartment of Anaesthesia and Trauma Centre, Centre of Head and
Orthopaedics, Copenhagen University Hospital, Rigshospitalet, Copenhagen,
decompression. The primary outcome was 30-day survival, i
Danish Air Ambulance and jFaculty of Health, Aarhus University, Aarhus, Denmark
and the key secondary outcome was prehospital ROSC.
Correspondence to Signe Amalie Wolthers, MD, Department of Clinical
Medicine, University of Copenhagen, Blegdamsvej 3B, 2200 Copenhagen N,
Main results A total of 223 patients with TCA were Denmark and Prehospital Center, Region Zealand, Ringstedgade 61, 4700
included. The median age was 54 years (IQR 34–68), and Naestved, Denmark
Tel: +45 22 56 60 56; e-mail: s.a.wolthers@gmail.com
the majority were males. Overall, 23% of patients achieved
prehospital ROSC, and the 30-day survival rate was 4%. Received 16 August 2023 Accepted 8 November 2023.

Supplemental digital content is available for this article. Direct URL citations ap- Background
pear in the printed text and are provided in the HTML and PDF versions of this
article on the journal's website (www.euro-emergencymed.com).
Traumatic cardiac arrest (TCA) is a critical condition associ-
This is an open-access article distributed under the terms of the Creative
ated with poor prognosis, and prompt, empirically grounded
Commons Attribution-Non Commercial-No Derivatives License 4.0 (CCBY- interventions are paramount in increasing survival rates [1,2].
NC-ND), where it is permissible to download and share the work provided it is
properly cited. The work cannot be changed in any way or used commercially Cardiac arrest resulting from traumatic origin represents
without permission from the journal. the end state of decompensated haemorrhagic shock,
0969-9546 Copyright © 2023 The Author(s). Published by Wolters Kluwer Health, Inc. DOI: 10.1097/MEJ.0000000000001108
 Prehospital interventions and outcomes in traumatic cardiac arrest Wolthers et al. 325

hypoxaemia, and/or obstructive shock, all potentially management, ultrasound examinations and procedures
reversible causes of TCA, with appropriate interventions such as thoracostomies and transfusion of blood products.
[1,3]. Hypovolaemia and traumatic brain injury are lead- Administration of blood products are transfused based on
ing contributors accounting for almost 90% of all cases of the European Resuscitation Guidelines, at the discretion
TCA [4]. These underlying factors are crucial in under- of the physician, with no strict indications. The Danish
standing the pathophysiology and management of TCA, HEMS administers two units of packed red blood cells
as they present significant opportunities for interventions and two units of liquid plasma (never frozen) for pre-
and potential improvement in patient outcomes. The hospital transfusion. In addition, it carries two bottles
management of TCA hinges on a time-critical assess- of freeze-dried plasma (Lyoplas). Further, the HEMS
ment and treatment of reversible causes, which takes assures fast transfer to specialised in-hospital care [9].
priority over chest compressions [1]. Thus, urgent action As of 2022, The rate per hour for HEMS missions in
is imperative, necessitating specialised prehospital inter- Denmark is approximately EUR 4900.
ventions and subsequent in-hospital advanced care in
dedicated trauma centres [1]. Participants
Historically, resuscitation efforts for TCA were consid- This study included all patients with TCA in Denmark
ered futile due to meagre survival rates. Yet, survival has between 2016 and 2021 who were clinically assessed
improved through the last decades, which is possibly by a Danish HEMS physician. The study included all
attributable to advancements in resuscitative techniques age groups, including patients declared dead on scene.
TCA was defined as cardiac arrest resulting from blunt,
and trauma care [4]. Data evaluating the HEMS in the
penetrating or burn injury, according to the Utstein tem-
setting of TCA remains scarce [3–5].
plate [13]. Patients were excluded if the HEMS was dis-
The rapid transport of patients to specialised facil- patched but did not arrive. Patients with cardiac arrest
ities has been identified as a contributing factor to the resulting from hanging, drowning, or electrocution were
observed benefits of using the HEMS in the setting of excluded. Further, patients without valid personal iden-
trauma. The role of the physician-staffed HEMS within tification numbers were excluded, as it was necessary for
the trauma system also contributes to these observed linkage to the Danish registries [14].
advantages. Finally, the expertise of the helicopter crew
is another identified factor [6–8]. However, a comprehen- Data collection
sive understanding of the epidemiology and treatment of The HEMS database, encompassing information on
TCA is imperative to improve care and potential survival all HEMS dispatches in Denmark, was established in
within this diverse subgroup of cardiac arrests. Thus, the October 2014 [11]. For this study, the cases from the
primary objective of the present study was to evaluate HEMS database were linked to data from the National
survival and return of spontaneous circulation (ROSC) Patient Registry [15] and the prehospital medical record.
and to investigate the characteristics of patients with Finally, survival outcomes were obtained from the
TCA assessed by the Danish HEMS. Danish Civil Registration Registry [14]. The linkage was
facilitated using the personal civil identification number.
Materials and methods
To identify cases of traumatic origin, a two-step process
Study design and data source
was employed. First, a search string was generated based
This study employed a retrospective population-based
on traumatic cases in the Danish Cardiac Arrest Registry,
cohort design with a 30-day follow-up period. The study
which includes a manual validation and review of all
included data from the national HEMS database on
out-of-hospital cardiac arrest (OHCA) cases. In the sec-
patients with TCA between 2016 and 2021.
ond step, the final search string containing the identified
trigger words was applied to data on all trauma and car-
Setting diac arrest cases in the HEMS database. The trauma and
The Danish EMS is a government-funded service free cardiac arrest cases were identified through the reported
of charge for all European Union citizens. The ground- diagnoses in the HEMS database. This last step was car-
based EMS has been supplemented by the Danish ried out to identify cases of TCA, which was manually
HEMS on a national level since 2014 [9,10]. The HEMS reviewed.
is staffed by a consultant-level anaesthesiologist, a pilot,
and a specially trained paramedic [11]. The HEMS is pri- Analyses
marily dispatched to time-critical emergencies, includ- Data reporting adhered to the STrengthening the
ing stroke, cardiac arrest, acute myocardial infarction or Reporting of OBservational studies in Epidemiology
severe trauma [11]. The dispatch criteria for the HEMS statement [16]. Descriptive statistics were presented
are described in detail elsewhere [9,12]. The HEMS ini- as absolute numbers, percentages, medians, and inter-
tiates advanced prehospital interventions both on scene quartile ranges. Non-parametric testing was performed
and during transport. These interventions include airway to examine subgroup differences. Categorical data
326 European Journal of Emergency Medicine 2024, Vol 31 No 5

were assessed using Fisher’s exact test. The factors the study aimed to gain insight into the effectiveness of
independently associated with ROSC were described interventions and identify factors that influence the like-
using logistic regression with adjusted odds ratios (OR) lihood of survival and ROSC in patients with TCA.
and corresponding 95% confidence intervals (95% CI).
The analyses were adjusted for age, sex, mechanism Ethical considerations
of injury, initial rhythm, thoracostomy, endotracheal All data used in this study were pseudonymised. The
intubation and time on scene. A directed acyclic graph study adhered to the General Data Protection Regulation.
was provided to illustrate the basis of the included Registration of the study and the ethical approval was reg-
variables [17] (supplementary digital content Fig. 1, istered and approved by the Regional Ethical Committee
Supplemental digital content 1, http://links.lww.com/ (Reference: EMN-2022-02731), the Danish Data Protection
EJEM/A417). Response time was defined as the time Agency (Reference: R-22019033 (RS)) and the Regional
from the initial call to the dispatch centre to the arrival Research Board (Reference: REG-031-2022). Since it was a
of the HEMS. Time on scene was defined as the time registry-based study, Danish legislation does not require
between the arrival of the HEMS and departure of the ethical committee approval or individual patient consent.
patient either by the HEMS or ground-based EMS.
Further, time on scene was dichotomised into more Results
or less than 20 min on scene and less than 20 min on Study population
scene based on findings from previous studies [18,19]. A total of 3284 patients with confirmed cardiac arrest were
Statistical significance was considered at a P-value of assessed by the Danish HEMS during the study period.
<0.05, and all statistical tests were performed using R Non-traumatic aetiology accounted for 2790 cases. A total
version 4.1.3 (2022-03-10). of 223 cases were included for analysis in this study (Fig.
1).
Objectives and outcomes
The median age of included patients was 54 years (IQR
The primary outcome was 30-day survival, and the key
34-68), and the majority were males, 183 cases (86%).
secondary outcome was prehospital ROSC. Further, pre-
Bystander cardiopulmonary resuscitation (CPR) was
hospital critical care interventions and prognostic factors
performed in 112 cases (56%). A non-shockable cardiac
associated with survival and prehospital ROSC were eval-
rhythm was observed in 191 cases (86%), while a shocka-
uated. The selection of ROSC as the outcome variable in
ble rhythm was observed in 17 cases (8%). The majority
the adjusted analyses was driven by the limited number
of patients suffered from blunt, high-energy trauma, 191
of survivors observed. By evaluating these outcomes,
cases (86%). Road collisions accounted for nearly two-
thirds of cases. The median time at the scene was 31 min
(IQR 22–41), and the median response time was 18 min
Fig. 1 (IQR 13–23) (Table 1).

Survival
The 30-day survival rate was 4%. Among patients in
the survival group, 6 cases (67%) presented with an
initial shockable rhythm; this was only true for 8 cases
(5%) in the non-survival group, P < 0.001. All patients in
the survival group underwent endotracheal intubation
compared to 119 cases (56%) in the non-survival group,
P = 0.001 (Table 2). The mechanism of injury in patients
who survived is presented in the supplementary Table
1, Supplemental digital content 2, http://links.lww.com/
EJEM/A418.

Return of spontaneous circulation

In total, 52 cases (23%) achieved prehospital ROSC.
Patients with ROSC were significantly older than patients
who did not achieve ROSC, with a median age of 59 years
(IQR 41–75) vs. 52 years (IQR 31–66), P = 0.011. An initial
shockable cardiac rhythm or an initial rhythm with a pal-
Revised STROBE flowchart of patient inclusion. HEMS, Helicopter pable pulse were more common in the ROSC group than
Emergency Medical Service; OHCA, out-of-hospital cardiac arrest;
STROBE, STrengthening the Reporting of OBservational studies in in the non-ROSC group, with P = 0.006 for both compar-
Epidemiology. isons. Endotracheal intubation was more frequent in the
ROSC group compared to the non-ROSC group, with 45
 Prehospital interventions and outcomes in traumatic cardiac arrest Wolthers et al. 327

Table 1 Baseline characteristics of patients with traumatic cardiac Table 2 Comparison of characteristics and prehospital interven-
arrest assessed by the Danish HEMS tions stratified by return of spontaneous circulation
N = 223a No ROSC, ROSC,
N = 170a N = 52a P-valueb
Age, years 54 [34–68]
 Missing 22 Age, years 52 (31–66) 59 (41–75) 0.01
Sex  Missing 19 3
 Female 30 (14) Sex 0.68
 Male 183 (86)  Female 23 (14) 6 (12)
 Missing 10  Male 138 (81) 45 (867)
Public location 170 (77)  Missing 9 1
 Missing 3 Mechanism of injury
Witnessed by bystander 114 (52)  Blunt, high-energy trauma 151 (89) 39 (75) 0.01
 Missing 10  Blunt, low-energy trauma 7 (4) 12 (23) <0.001
CPR by bystander 112 (56)  Burn 3 (2) 0 (0) >0.99
 Missing 22  Penetrating trauma 9 (5) 1 (2) 0.46
Initial cardiac rhythm Response time, minutes 18 [13–23) 18 [14–27] 0.38
 Shockable 17 (8) CPR by EMS personnel 149 (88) 52 (100) 0.03
 Non-shockable 190 (88) Mechanical CPR 44 (25) 7 (13) 0.30
 Cardiac rhythm with a palpable pulse 9 (4) Initial cardiac rhythm
 Missing 7  Shockable cardiac rhythm 8 (5) 9 (17) 0.05
Mechanism of injury  Non-shockable cardiac rhythm 156 (92) 34 (65) <0.001
 Blunt, high-energy trauma 191 (86)  Cardiac rhythm with a palpable pulse 3 (2) 6 (12) 0.05
 Blunt, low-energy trauma 19 (9)  Missing 3 3
 Burn 3 (1) Airway management
 Penetrating trauma 10 (5)  Endotracheal intubation 83 (49) 45 (87) <0.001
Classification of trauma  Surgical airway 1 (1) 1 (2) 0.41
 Blunt trauma (various) 29 (13)  Supraglottic airway device 1 (1) 0 (0) >0.99
 Burn 3 (1)  Bag mask ventilation 19 (11) 0 (0) 0.01
 Fall less than 2 m 10 (5)  None 64 (38) 6 (12) <0.001
 Fall more than 2 m 17 (8)  Missing 2 0
Gunshot 2 (1) Ultrasound examination 58 (37) 33 (67) <0.001
 Isolated head injury 5 (2)  Missing 12 3
 Miscellaneous 6 (3) Thoracal decompression
 Road collision 143 (64)  Thoracostomy (mini-thoracostomy) 81 (48) 27 (52) 0.60
 Stab 8 (4)  Needle decompression 2 (1) 0 (0) >0.99
Time on scene, minutes 31 [22–41]  None 87 (51) 25 (48) 0.70
Response time, minutes 18 [13–23] Thoracotomy 5 (3) 1 (2) >0.999
Use of blood products 65 (38) 28 (54) 0.05
CPR, cardiopulmonary resuscitation. Time on scene, minutes 31 [22–42] 30 [24–40] 0.94
a
Median [IQR]; n (%).
CPR, cardiopulmonary resuscitation; EMS, emergency medical service; ROSC,
return of spontaneous circulation.
a
Median [IQR]; n (%).
cases (87%) vs. 83 cases (49%), P < 0.001. Finally, admin- b
Wilcoxon rank test; Fisher’s exact test; Pearson’s Chi-squared test. There was
istration of blood products occurred more frequently in one patient with missing data on return of spontaneous circulation.
the ROSC group compared to the non-ROSC group, in
28 cases (54%) vs. in 65 cases (38%), P = 0.051. There
were no statistically significant differences in response In the adjusted analysis of prehospital interventions,
time or time on scene between the two groups (Table 3). endotracheal intubation was associated with an increased
likelihood of achieving ROSC, OR of 7.10 (95% CI 2.55–
22.85). Conversely, thoracostomy was associated with a
Prehospital interventions decreased likelihood of achieving ROSC, with an OR
Among TCA patients, CPR was performed by EMS per- 0.35 (95% CI 0.13–0.91). Examination by ultrasound,
sonnel in 207 (93%) cases. The remaining part of cases were administration of blood products, time on scene > 20 min,
declared dead without initiation of CPR by EMS personnel. sex and age did not contribute significantly to the associa-
Patients were defibrillated by EMS personnel in 31 cases tion of achieving ROSC (Fig. 3).
(14%). Endotracheal intubation was performed in 83 cases
(49%). Blood products were administered in 94 cases (42%).
The geographical location of TCAs assessed by the
Thoracic decompression was performed by needle decom-
HEMS
pression in 2 cases (1%) and thoracostomy in 81 cases (48%).
The patients with TCA assessed by the HEMS were
Tranexamic acid was administered to one in four patients,
predominantly located in less densely populated areas.
and adrenalin was administered to two in three.
In contrast, the incidence of HEMS-assessed TCA
In the adjusted analysis of pre- and intra-arrest factors, cases near the four main cities of Denmark was low.
an initial shockable cardiac rhythm was associated with Remarkably, a significantly higher incidence of TCA
an increased likelihood of achieving ROSC, OR of 3.78 patients assessed by the HEMS was observed in the
(95% CI 1.33–11.00). When evaluating the mechanism of vicinity of the four HEMS bases (Supplementary digital
injury, penetrating trauma showed an OR of 0.57 (95% CI content Fig. 2, Supplemental digital content 3, http://links.
0.03–3.46) for achieving ROSC (Fig. 2). lww.com/EJEM/A419).
328 European Journal of Emergency Medicine 2024, Vol 31 No 5

Table 3 Comparison of patients with traumatic cardiac arrest This study found no significant association between the
stratified by 30-day survival mechanism of injury and outcome. Nonetheless, the
Non-survivors, Survivors, overrepresentation of blunt trauma within this study
N = 214a N = 9a P-valueb
must be considered when interpreting these results.
Age, years 55 [34–70] 54 [41–56] 0.36 Similar to prior literature, road collisions accounted for
 Missing 22 0
Sex 0.58
most TCAs in this study [22]. The association between
 Female 30 (14) 0 (0) the mechanism of injury and survival has been debated,
 Male 174 (81) 9 (100) yielding inconsistent results [23]. Differing inclusion cri-
 Missing 10 (5) 0 (0)
Mechanism of injury teria and regional variations might explain outcome dis-
 Blunt, high-energy trauma 184 (86) 7 (78) 0.62 parities across studies.
 Blunt, low-energy trauma 17 (8) 2 (22) 0.17
 Burn 3 (1) 0 (0) >0.99 Endotracheal intubation demonstrated a statistically sig-
 Penetrating trauma 10 (5) 0 (0) >0.99
Response time, minutes 18 [13–23] 15 [11–19] 0.28 nificant association with ROSC. However, this present
Initial cardiac rhythm study did not assess the timing of prehospital endotra-
 Shockable cardiac rhythm 11 (5) 6 (68) <0.001
 Non-shockable cardiac rhythm 189 (88) 1 (11) <0.001 cheal intubation, and some patients may have been
 Cardiac rhythm with a palpable pulse 8 (4) 1 (11) 0.32 intubated after achieving ROSC. Yet, these findings are
 Missing 6 1
Airway management
consistent with intubation rates reported by ter Avest et
 Endotracheal intubation 119 (56) 9 (100.0) 0.01 al. [5] One possible explanation for the observed associ-
 Surgical airway 2 (1) 0 (0) >0.99 ation between endotracheal intubation and ROSC is the
 Supraglottic airway device 1 (1) 0 (0) >0.99
 Bag mask ventilation 19 (9) 0 (0) >0.99 presence of disease severity bias. In cases where treat-
 None 70 (33) 0 (0) 0.06 ment was deemed futile, endotracheal intubation may
 Missing 4 0 (0)
Ultrasound examination 86 (40) 5 (57) 0.32 have been withheld. Whereas patients with a perceived
Thoracal decompression higher chance for survival may have been more inclined
 Thoracostomy (mini-thoracostomy) 103 (48) 5 (57) 0.74
 Needle decompression 2 (1) 0 (0) >0.99
to undergo endotracheal intubation. This proposed rela-
 None 109 (51) 4 (44) 0.75 tionship underscores the complex prehospital decision-
Thoracotomy 6 (3) 0 (0) >0.99 making, where the perceived patient prognosis may
Use of blood products 92 (42) 2 (22) 0.31
Time on scene, minutes 32 [22–42] 26 [16–28] 0.02 influence the determination of appropriate interventions.
a
Median [IQR]; n (%). In this study, thoracostomy was performed in 48% of
b
Wilcoxon rank test; Fisher’s exact test. Survival was defined as 30-day survival. cases, aligning with the findings from the Netherlands [3]
but notably lower than the UK’s 84% rate [5]. The three
studies had comparable proportions of blunt trauma [3,5].
Discussion The described negative effect of thoracotomy on ROSC
This study investigated trauma patients with car- in this study has been described previously [5].
diac arrest who were assessed by the Danish HEMS.
The main finding was that approximately one in four Uncontrolled haemorrhage accounts for a substantial pro-
achieved prehospital ROSC, with a 30-day survival rate portion of early fatal trauma. Three recent randomised
of 4%. trials have assessed prehospital blood product usage with
divergent outcomes [24–26]. Heterogeneity within injury-
Despite advancements in resuscitation efforts and to-admission time, mechanism of injury, and severity may
increased survival rates, these findings underscore the explain differences. In this study, the use of blood prod-
dire prognosis of TCA [5]. The observed survival rate ucts did not contribute to the association with ROSC in
in this study is similar to studies from the Netherlands the multivariable analysis, and only 22% of the survivors
and the UK [3,5]. Notably, the research group behind received prehospital blood products. These findings sug-
this present study recently conducted a study on TCA, gest the need for targeted evaluation of blood product
primarily assessed by the ground-based EMS. A 30-day use in specific TCA subgroups, potentially optimising
survival rate of 8% was found within this cohort, sug- haemorrhage management.
gesting the presence of disease severity bias within the
HEMS population [20]. This has also been described Time spent on scene has been debated in trauma litera-
in other studies evaluating physician-staffed HEMS ture [27]. Recent evidence suggests that along with early
systems [9,21]. Response and transport time disparities identification and addressing reversible causes, traumat-
between the ground-based EMS and the HEMS might ically injured patients with TCA or pre-TCA should be
also influence reported survival discrepancies. The evi- expeditiously transferred and treated at a specialised
dence base for patients assessed by the HEMS remains trauma centre whenever feasible [1]. Nonetheless, data
limited. Comparisons between patients assessed by the on time spent on scene are lacking. The number of inter-
HEMS and ground-based EMS may clarify the impact ventions has been found to be associated with increased
of the HEMS dispatch criteria, as the ground EMS may mortality, explained by confounding by indication [18].
exhibit heterogeneity in medical authority, education and Time on scene exceeding 20 min did not significantly
experience [6]. impact the likelihood of ROSC.
 Prehospital interventions and outcomes in traumatic cardiac arrest Wolthers et al. 329

Fig. 2

Multivariable analysis of return of spontaneous circulation and potential prognostic pre- and intra-arrest factors in patients with traumatic cardiac
arrest. The analysis was adjusted for age, sex, initial shockable rhythm, and penetrating trauma. OR, odds ratio.

Fig. 3

Multivariable analysis of return of spontaneous circulation and associated prehospital interventions in patients with traumatic cardiac arrest. The
analysis was adjusted for age, sex, endotracheal intubation, ultrasound examination, administration of blood products, thoracostomy and time on
scene >20 min. OR, odds ratio.
330 European Journal of Emergency Medicine 2024, Vol 31 No 5

The presence of an initial shockable cardiac rhythm has outcomes included an initial shockable cardiac rhythm
been identified as a central prognostic factor for both and endotracheal intubation. Overall, this study empha-
survival and ROSC in this study. This finding has also sises the critical role of prehospital care and the need for
been supported by previous research [23,28]. Further, it ongoing advancements in managing trauma patients with
has been suggested that this subgroup of cases may have cardiac arrest.
encompassed patients who sustained a cardiac arrest of
cardiac origin prior to the trauma. These patients are Acknowledgements
more likely characterised by a shockable cardiac rhythm. Conflicts of interest
With this aetiology being associated with a more favoura- There are no conflicts of interest.
ble likelihood for ROSC and survival [29].
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