Western Journal of Emergency Medicine: Integrating Emergency Care with Population Health

Introduction: Traumatic cardiac arrest is associated with poor survival and significant consumption of hospital resources. Determining which patients have survivable injuries allows for judicious use of resources. Our aim was to determine whether cardiac activity on point-of-care ultrasound (POCUS) during traumatic cardiac arrest was associated with increased patient survival and the charges of continued resuscitation in patients that do have cardiac activity on POCUS.

Methods: We conducted this single-center retrospective study at an urban, Level I trauma center of consecutive patients arriving in traumatic cardiac arrest from August 2016–December 2023 who had a cardiac POCUS performed during the initial resuscitation efforts. Our primary outcome was to determine whether cardiac activity on POCUS during the arrest was associated with increased patient survival to neurologically intact hospital discharge. Secondary objectives included determining whether there was a correlation between cardiac activity on POCUS during traumatic cardiac arrest and survival to hospital admission. Additionally, we evaluated hospital charges and length of stay associated with continued resuscitation in patients who demonstrated cardiac activity on ultrasound.

Results: We identified 134 patients in traumatic cardiac arrest, of whom 74 (55.2%) had a cardiac POCUS performed and met inclusion criteria. A total of 17 patients had cardiac activity noted on the initial POCUS, with two (11%) surviving to hospital discharge (95% CI, 1.3-39.7). The two survivors initially categorized as being in traumatic cardiac arrest were ultimately found to have medical etiologies and not trauma. Of the 57 patients who had no cardiac activity noted on POCUS, none survived to hospital discharge (95% CI, 0-6.3%). More patients survived to hospital admission who had cardiac activity on their initial POCUS compared with those who had no cardiac activity (odds ratio [OR], 49.8; 95% CI, 5.5-446.9; P < .001). More patients survived to hospital discharge as well, but this was not statistically significant (OR, 18.6; 95% CI, 0.84-406.7, P = .06). Traumatic cardiac arrest patients who had present cardiac activity had longer code times prior to terminating efforts (26.6 vs 7.7 minutes, P < .001) and had higher overall charges per patient ($91,321 vs $10,032), P < .001).

Conclusion: The absence of cardiac activity on POCUS in patients with traumatic cardiac activity is likely to be fatal. The presence of cardiac activity was associated with increased resuscitation times, charges, and survival to hospital admission but not necessarily to hospital discharge.