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The following is a summary of “Should Anything Else Be Done Besides Prehospital CPR? The Role of CPR and Prehospital Interventions After Traumatic Cardiac Arrest,” published in the March 2025 issue of Journal of Emergency Medicine by McWilliam et al. 

Despite common practice, prehospital Cardiopulmonary resuscitation (CPR) for traumatic cardiac arrest (TCA) lacks universal implementation due to perceived variability in effectiveness, leading to inconsistent application.  

Researchers conducted a retrospective study to identify factors associated with survival following TCA.   

They analyzed adults transported to the trauma center after receiving CPR at the scene or during transit between January 1, 2014, and December 31, 2022. Individuals who arrived at the ED with and without a pulse following CPR for TCA were compared. Multivariate logistic regression identified interventions independently linked to having a pulse upon ED arrival, (CPR, traumatic cardiac arrest, emergency department, ED, January 1, 2014 – December 31, 2022).  

The results showed that 244 individuals met the inclusion criteria, with 30% having a pulse upon ED arrival. No significant differences were found in age (41 vs 40 years, P =0.44), ISS (33 vs 36, P =0.20), air transport (13% vs 19%, P =0.14), male sex (81% vs 77%, P =0.51), or transport time (11 minutes vs 15 minutes, P =0.16). However, differences were observed in blunt trauma (76% vs 63%, P =0.04), prehospital thoracostomy (39% vs 55%, P =0.02), tourniquet use (1% vs. 8%, P=0.045), and defibrillation (17% vs 7%, P =0.02). Mortality among those who arrived with a pulse was 65%. Multivariate logistic regression identified penetrating trauma and prehospital thoracostomy as independent factors associated with a higher likelihood of having a pulse upon arrival.  

Investigators concluded that patients with TCA who received prehospital CPR and arrived with a pulse had a 35% survival rate, with penetrating trauma and prehospital thoracostomy being associated with pulse return, potentially due to tension pneumothorax relief. 

Source: jem-journal.com/article/S0736-4679(25)00096-4/abstract