Prehospital management and outcomes of traumatic cardiac arrest in older adults: a French nationwide registry study
Abstract
Background Traumatic cardiac arrest (TCA) carries an overall poor prognosis, yet the impact of advanced age on prehospital management and outcomes remains poorly characterised. Whether older patients with TCA present distinct clinical profiles or respond differently to resuscitation compared with younger adults is largely unknown. Methods We conducted a multicenter cohort study using data from the French National Out-of-Hospital Cardiac Arrest Registry (RéAC). All adult patients (≥18 years) with out-of-hospital TCA were included. Patients were categorised as adults (18–64 years) or older adults (≥65 years). The primary outcome was return of spontaneous circulation (ROSC). Secondary outcomes included survival at hospital admission (D0), 30-day survival (D30), and favourable neurological outcome (Cerebral Performance Category 1–2 at D30). Univariate and multivariable logistic regression analyses were performed. A pre-specified subgroup analysis stratified older patients into three age categories (65–74, 75–84, ≥85 years). Results Among 5595 patients (4249 younger adults; 1346 older adults [24.1%]), older patients more often achieved ROSC (22.5% vs 18.6%; OR 1.22, 95%CI 1.03–1.45) but were less likely to survive to 30 days (0.5% vs 1.2%; OR 0.34, 95%CI 0.15–0.81). Survival at hospital admission did not differ after adjustment (16.1% vs 13.3%; OR 1.14, 95%CI 0.95–1.38). Older patients more often sustained a fall (52.2% vs 28.5%) and less often sustained thoracic injuries (43.8% vs 59.6%). They received fewer trauma-specific prehospital interventions, most notably thoracostomy (15.2% vs 23.9%) and fluid resuscitation (28.3% vs 37.4%). Conclusions In this large French registry study, older patients with TCA achieved return of spontaneous circulation more often than younger adults but were less likely to survive to 30 days. Age alone should not preclude resuscitative efforts, but a concurrent or precipitating medical cause of arrest should be systematically considered in this population.