Prehospital factors of survival to hospital admission in blunt traumatic out-of-hospital cardiac arrest: a nationwide 11-year study

Abstract

Background: Blunt traumatic out-of-hospital cardiac arrest (TOHCA) is consistently associated with poor survival outcomes. Although the prehospital interventions may influence prognosis. This study aimed to identify independent prehospital factors associated with survival to hospital admission among patients of blunt TOHCA in Thailand. Methods: This retrospective cohort study used nationwide data from the Information Technology of Emergency Medical System database between 2012 and 2022. Patients of all ages with blunt TOHCA who received prehospital resuscitation and were transported to the emergency department were included. The primary outcome was survival to hospital admission. Multivariable logistic regression was used to identify associated prehospital factors. Results: Of 18,612 patients with blunt TOHCA, 3,004 (16.1 %) survived to hospital admission. The survival rate declined from 28 % in 2012 to 13 % in 2022. Several independent factors associated with improved survival, including external bleeding control (adjusted odds ratio [aOR] 1.20, 95 % confidence interval [CI]: 1.03–1.40), endotracheal intubation (aOR 2.12, 95 % CI: 1.74–2.58), intravenous fluid administration (aOR 1.65, 95 % CI: 1.32–2.06), defibrillation (aOR 2.40, 95 % CI: 1.99–2.90), longer on-scene time (aOR 1.03, 95 % CI: 1.02–1.03), and head/neck injuries (aOR 1.30, 95 % CI: 1.11–1.51). In contrast, longer hospital-to-scene distances, chest/clavicle injuries, and open/closed fractures were associated with decreased odds of survival. Conclusion: This study highlights critical challenges in the prehospital management of blunt TOHCA in Thailand. Timely and appropriate interventions, including bleeding control, airway management, intravenous fluid administration, and defibrillation, may enhance survival outcomes.