There is controversy about the effectiveness of adrenaline in traumatic cardiac arrest. This study reports the patient characteristics and outcomes of adults with trauma-related out of hospital cardiac arrest treated with adrenaline or placebo. This post-hoc, sub-group analysis of the Pre-hospital Randomised Assessment of Adrenaline in Cardiac Arrest-2 (PARAMEDIC-2) trial explored the effect of adrenaline on survival to hospital admission, longer-term survival and neurological outcomes amongst adults with trauma related out of hospital cardiac arrest. Individual patients were randomised through opening a single treatment pack which contained either 10 doses of 1mg adrenaline or 0.9% saline placebo. Treating clinicians, investigators, outcome assessors and patients were blinded to treatment allocation. The primary outcome was survival to 30days post cardiac arrest. 123 of 8,014 enrolled patients (1.5%) sustained a traumatic cardiac arrest (66 in the adrenaline arm and 57 in the placebo arm). Three times as many patients were admitted to hospital alive in the adrenaline arm 16/66 (24.2%) compared to 5/56 (8.9%) in the placebo arm, unadjusted odds ratio 3.3 (95% confidence interval 1.1 to 9.6), p=0.03; adjusted odd ratio 5.6 (95% CI 1.6 to 20.4), p=0.009. A single patient, in the adrenaline arm, survived beyond 30days (1/66 (1.5%) compared to 0/57 (0%)), who also experienced a favourable neurological outcome. Adrenaline was associated with a trebling of the rate of survival to hospital admission. These data support the use of adrenaline in trauma related out of hospital cardiac arrest. ISRCTN73485024.

The management of traumatic cardiac arrest (TCA) focuses on the immediate treatment of reversible causes, including bilateral thoracostomy. In our prehospital emergency service, bilateral thoracostomy has been recommended since 2012 for the management of TCA. We sought to analyse the prehospital management and clinical course of patients with TCA, focusing on changes over time in the use of thoracostomy. In this single-centre retrospective observational study, we included patients with TCA managed by physicians of the prehospital service of Lausanne University Hospital from 2012 to 2024. The primary outcome was the annual rate of bilateral thoracostomy. Secondary outcomes included the rate of additional on-site measures, such as pelvic binder placement and airway management, and follow-up at 48h. Among 3206 cardiac arrests during the study period, 473 (15%) were TCAs. Among the 247 patients with resuscitation attempts, thoracostomy was judged as indicated in 223 (90%) and performed in 148 (66%). Twenty-seven (18%) patients who had a thoracostomy were alive on arrival at hospital, with 9 (6.1%) still alive at 48h. The mean annual proportion of patients in whom a thoracostomy was performed was 68% (range 0-100%) and increased significantly over the years (p<0.001). The annual rate of thoracostomy in TCA patients increased significantly in the period 2012 to 2024. Larger studies are required to determine the impact of thoracostomy on survival.

This study aimed to describe the characteristics of patients requiring tracheostomy following extracorporeal cardiopulmonary resuscitation (ECPR) for out-of-hospital cardiac arrest (OHCA) using real-world data from a multicenter registry. This was a secondary analysis of the SAVE-J II study, a retrospective multicenter registry study in Japan. Patients with OHCA aged ≥18years who underwent ECPR between January 2013 and December 2018 were included. Participants were classified into the tracheostomy and non-tracheostomy groups, with the tracheostomy group further categorized into early (≤10days) and late (>10days) subgroups. Survival and favorable neurological outcome at hospital discharge were the primary outcomes. Overall, this study included 1,910 patients with a median age of 61 (interquartile range [IQR], 49-69) years, of whom 1,610 (82.6%) were male. Of the participants, 276 (14.5%) underwent tracheostomy, with 224 (81.2%) and 44 (15.9%) surviving to discharge and achieving favorable neurological outcomes at hospital discharge, respectively. The median duration to tracheostomy was 10 (IQR, 8-14) days, with 98% of tracheostomies performed following extracorporeal membrane oxygenation (ECMO) weaning. The early tracheostomy group accounted for 145 patients (54.7%). The early and late tracheostomy subgroups showed no significant differences in survival or favorable neurological outcomes at discharge. Following ECPR, 14.5% of the patients underwent tracheostomy, with the majority performed following ECMO weaning. Although the survival rate at discharge among these patients was 81.2%, only 15.9% exhibited favorable neurological outcomes. To explore the long-term outcomes of patients treated with ECPR for OHCA, future studies are needed.