Traumatic cardiac arrest in older adults in the United States

Traumatic cardiac arrest is associated with lower survival rates compared with other arrest etiologies. Relatively little research has examined potential variation in traumatic cardiac arrest parameters as a function of patient age. We hypothesize that traumatic cardiac arrest in the older adult population may be appreciably different with regards to demographics and clinical features from traumatic cardiac arrest in other age groups.

We examined a nationally-representative database of emergency medical services (EMS) activations in the United States (NEMSIS). We included all adult (≥18 years) out-of-hospital cardiac arrests responded to by ground ambulance EMS crews in 2022 and 2023 documented as having a traumatic etiology. Arrests were grouped based on whether they involved adult patients (18-60 years) or older adult patients (61+ years) based on pre-existing classifications within the dataset. Key arrest data were compared across the two groups using two-tailed two-proportion z-tests; significance was defined as p < 0.05.

Across 10,573 older adult (61+ years) traumatic cardiac arrests and 34,203 adult (18-60 years) traumatic cardiac arrests, traumatic cardiac arrests in older adults were less likely to be witnessed (35.9 % vs. 39.5 %; p < 0.00001), less likely to receive pre-EMS cardiopulmonary resuscitation (CPR) (29.7 % vs. 33.1 %; p < 0.00001), more likely to be initially-shockable (3.7 % vs. 2.4 %; p < 0.00001), and more likely to achieve return of spontaneous circulation (ROSC) (11.3 % vs. 7.5 %; p < 0.00001). Traumatic cardiac arrests in older adults were also less likely to be associated with mass casualty incidents (MCIs) (0.7 % vs. 0.9 %; p = 0.02642) or the use of alcohol/drugs (3.5 % vs. 6.4 %; p < 0.00001).

Our analysis of a large and nationally-representative database of EMS activations in the United States reveals traumatic cardiac arrest in older adults is associated with several key differences. Further study is needed to identify potential mechanisms underpinning these differences and develop approaches to mitigate the risk of traumatic cardiac arrest across all ages.