Abstract 254: Patients With Signs of Life on Hospital Arrival Have a Higher Chance of Survival and Favorable Neurological Outcomes Following Traumatic Cardiac Arrest

Introduction: The clinical impact of signs of life (SOL) in traumatic cardiac arrest (TCA) remain to be elucidated. A previous study compared TCA patients with pulseless electrical activity (PEA) to those with asystole, but survival was not significantly different between the groups. Other obvious SOL (i.e., fine extremity/eye movement, light reflection, agonal respiration) have not yet been examined in TCA.

Hypothesis: We hypothesized that TCA patients with SOL on hospital arrival have a higher chance of survival and good neurological outcomes.

Aim: To examine survival and neurological outcomes in TCA patients with or without SOL.

Methods: Retrospective review of data from the Japan Trauma Data Bank (2019-2021). The inclusion criteria were patients with TCA on arrival. The exclusion criteria were patients with burns, abbreviated injury scale score> 6 in any region, and missing survival or SOL data. SOL was defined as follows: extremity or eye movement, light reflex, gasping, pulseless electrical activity with electrical heart activity > 40 beats per minute. The primary outcome was survival at discharge. The secondary outcome was favorable neurological outcome (Glasgow Outcome Scale score of 4 or 5) at hospital discharge. Patients with and without SOL were compared using univariable analysis. Results were described with odds ratio (ORs) and 95% confidence intervals (CI).

Results: A total of 2,136 patients (121 with SOL and 2,015 without SOL) were included. The characteristics of patients with or without SOL were as follows: age (median age 60.5 years old [interquartile range: 42-80 years] vs. 55.2 [38-75]), gender (male: 83/121 (68.6%) vs. 1,321/2,015 (65.9%), Injury Severity Score (32.9 [22-43] vs. 33.7 [22-41]), blunt trauma (97/121 (82.2%) vs. 1,711/2,015 (84.9%)), and transportation time (15.1 min [7-18] vs. 13.3 [7-16]). The patients with SOL showed higher survival compared with the patients without SOL (11/121 (8.5%) vs. 24/2015 (1.2%), OR 1.9 [CI 1.38-2.85]). A similar trend was observed for favorable neurological outcomes (5/95 (5.3%) vs. 7/1,440 (0.5%), OR 2.41 [CI 1.26-3.60]).

Conclusions: TCA patients with SOL at arrival showed higher survival and favorable neurological outcomes at hospital discharge compared with TCA patients without SOL.