Morcel B, Yordanov Y, Mercier E, David JS, Gauss T, Tazarourte K, Benhamed A
Scand J Trauma Resusc Emerg Med . 2026 May 20
doi: 10.1186/s13049-026-01622-4.
PMID: 42157171
ABSTRACT
Background: While volume-outcome relationships for non-traumatic out-of-hospital cardiac arrest have been reported in hospital settings, the impact of prehospital exposure, particularly for the rare and clinically complex entity of traumatic cardiac arrest (TCA), remains uncertain and may influence emergency medical services (EMS) proficiency and survival. The study aimed to assess the relationship between exposure of emergency medical services to traumatic cardiac arrest cases and patients' survival.
Methods: We conducted a multicentre retrospective cohort study using data from the French nationwide out of hospital cardiac arrest registry (RéAC) from July 2011 to March 2023. EMS volume was defined by the number of traumatic cardiac arrests managed by physician-staffed EMS per year of participation in the registry. The primary outcome was survival upon hospital admission. Secondary outcomes included return of spontaneous circulation (ROSC), 30-day survival, and 30-day survival with a favourable neurological outcome. We also investigated key prehospital management variables such as epinephrine administration, intubation, haemorrhage control procedures, fluid resuscitation, blood transfusion, thoracostomy, on-scene time and transport time. A multivariable mixed model was used to account for differences in baseline characteristics.
Results: Among 151,658 out-of-hospital cardiac arrest, 6,263 were identified as TCA (age 45 years [IQR 29;63]; 77% male) treated across 175 EMS bases. EMS volume ranged from 0.02 to 3.28 TCA per year. No significant relationship was observed between EMS volume and survival to hospital admission (OR 1.00; 95% CI [0.99-1.01]; p = 0.7), as well as with ROSC (OR 1.00; 95% CI [0.99-1.01]; p > 0.9), 30-day survival (OR 1.01; 95% CI [0.98-1.05]; p = 0.4) or 30-day survival with favourable neurological outcome (OR 1.02; 95% CI [0.97-1.07]; p = 0.4). Similarly, no significant associations were observed in pre-hospital interventions or on-scene and transportation times.
Conclusions: EMS activity was not associated with differences in outcomes or management for traumatic cardiac arrest. Its rarity and lethality may hinder the acquisition and maintenance of provider expertise, highlighting the importance of targeted training.
Keywords: Emergency medical services; Out-of-hospital cardiac arrest; Survival; Trauma; Volume.
