Influence of pulseless electrical activity and asystole on the prognosis of patients with traumatic cardiac arrest: A retrospective cohort study.

Background: 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.

Methods: 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.

Results: 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).

Conclusion: 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.