Comparative Analysis of Traumatic Cardiac Arrest: Role of Early Intervention and Care Pathway

(1) Background: This study aimed to assess the characteristics and factors influencing 72 h survival after traumatic cardiac arrest (TCA), comparing out-of-hospital TCA (oTCA) with in-hospital TCA (iTCA). (2) Methods: This is a retrospective review of 286 patients with TCA admitted to the regional trauma center (RTC) in Gangwon Province, Korea, between 2013 and 2019. (3) Results: Transfer from another hospital (hazard ratio [HR] 0.86 [0.76-0.97]) and longer duration between accident and cardiopulmonary resuscitation (CPR) (HR 0.95 [0.90-0.99]) were associated with lower 72 h mortality. Transfer showed a significant association with lower 72 h mortality in all patients and in the high-injury-severity-score (ISS) group, but not in the low-ISS group. Subgroup analysis indicated that patients transferred from another hospital had significantly lower HR than directly admitted patients to the RTC for oTCA occurrence (HR 0.36 [0.23-0.57]), total CPR duration > 30 min (HR 0.34 [0.23-0.52]), and accident-to-CPR duration < 30 min (HR 0.25 [0.11-0.55]). Additionally, shorter distances from the accident site to the first hospital were associated with lower relative HRs. (4) Conclusions: Considering the extremely poor outcomes of TCA, basic resuscitation and evaluation at nearby medical institutions rather than immediate transfer to specialized trauma centers, particularly when TCA occurs or is anticipated, are important. Early damage-control resuscitation at a nearby hospital can impact on improving the survival rate of patients with TCA.