Mechanical and manual cardiopulmonary resuscitation in traumatic cardiac arrest: a retrospective observational study.

backgroundPrehospital Traumatic cardiac arrest has a high fatality rate despite advances in trauma systems and resuscitation strategies. Mechanical chest compression devices have been increasingly adopted to optimize cardiopulmonary resuscitation (CPR) during Emergency Medical Services (EMS) transportation. We aimed to evaluate the impact of CPR (mechanical during transportation versus manual CPR only at the scene) on survival among trauma patients.

methodsA retrospective analysis was conducted for patients who received CPR at the scene and during transportation to the hospital between 2016 and 2024.

resultsA total of 610 patients sustaining blunt traumatic cardiac arrest were included. The mean age was 34 ± 12.6 years; 94.6% were male, and 5.4% were female patients. Two hundred twenty (36.1%) received mechanical CPR during transportation to the hospital, and 390 (63.9%) received manual CPR only at the scene. Compared with the manual CPR group, the mechanical CPR group had higher rates of primary chest injury (30.5% vs. 20.5%; p = 0.006), bystander CPR (15.9% vs. 6.7%; p = 0.001), adrenaline administrations (95% vs. 26.4%; p = 0.001), and initial non-shockable rhythm (80% vs. 27.2%; p = 0.001). The two groups were comparable in median Injury Severity Score (ISS), head Abbreviated Injury Score (AIS), and total transport time. Mechanical CPR was associated with a markedly higher survival to hospital arrival (98.6% vs. 38.5%, p = 0.001), however, the rate of return of spontaneous circulation (ROSC) on arrival to the hospital remained low in both groups (10.5% with mechanical CPR vs. 5.9% with manual CPR, p = 0.041), and the overall 30-day survival rate for the entire cohort was just 0.7% (n = 4/610). The first 24-hour in-hospital survival rate was significantly higher in the mechanical CPR group than in the manual CPR group (93.1% vs. 89.3%). Among survivors to hospital arrival, the 30-day survival rate was 1.1% (n = 4/367) overall, 2.7% (n = 4/150), in the manual CPR group, and 0% (n = 0/217) in the mechanical CPR group. Age-gender-adjusted predictors for ROSC at handover were ISS (aOR 0.97; 95% confidence interval (CI) 0.95-0.99, p = 0.03) and thoracentesis (aOR 3.9; 95% CI 1.50-9.98, p = 0.005).

conclusionsMechanical CPR in prehospital blunt traumatic cardiac arrest was associated with improved survival to hospital arrival compared with manual CPR; however, in-hospital mortality remained extremely high. These findings suggest that mechanical CPR may facilitate transport of patients in traumatic cardiac arrest without substantially improving overall outcomes. While mechanical devices can provide continuous chest compressions during transport, their impact on meaningful survival in the trauma setting appears limited. The effect of potential iatrogenic injuries associated with the CPR process itself was lacking in this study. Further studies are needed to clarify the role and indication of prehospital mechanical CPR in traumatic cardiac arrest. CLINICAL TRIAL NUMBER: Not applicable for this retrospective study.