Traumatic cardiac arrest: what's HOT and what's not

Traumatic cardiac arrest (TCA) is a rare event in the pre-hospital setting, with only 0.3% of 227 994 submissions to Trauma Audit and Research Network (TARN) (Barnard et al, 2017a), estimated at 4 per 100 000 of the population annually (Irfan et al, 2017). Outcome following TCA has been widely debated over many years, and the problem is exacerbated by a wide range of outcome measures being quoted as survival, such as return of spontaneous circulation (ROSC) on scene, ROSC at hospital, and neurological outcome at discharge.

A 2016 review of TARN data by Barnard et al (2017a) reported 30-day survival following pre-hospital TCA as 7.5%. Konesky and Guo (2017) retrospectively analysed outcome in 124 patients who suffered TCA. They found 7.3% survival with complete neurological recovery. As a comparison, Irfan et al (2017) report overall survival as 2.4% in 410 patients who suffered TCA. A systematic review by Zwingmann et al (2012) reported overall survival at 7.2%, with varying degrees of neurological outcome. It is important to note that, in England, the introduction of the Major Trauma Networks has significantly changed the way major trauma patients are managed, and this may have an impact on mortality.