Impact of Direct Transport vs. Transfer on Out-of-Hospital Traumatic Cardiac Arrest.

Background: Injured patients benefit from direct transport to a trauma center; however, it is unknown whether patients with traumatic out-of-hospital cardiac arrest (OHCA) benefit from initial resuscitation at the nearest emergency department (ED) if a trauma center is farther away. We hypothesized that patients with traumatic OHCA transported directly to a trauma center have less in-hospital mortality after initial resuscitation compared to those transferred from non-trauma centers.
Methods: We examined patients presenting with traumatic OHCA within our institutional trauma registry and the National Trauma Data Bank (NTDB) and excluded patients with ED mortality. Our primary outcome was all-cause mortality during index hospitalization; multiple logistic regression controlled for age, sex, injury severity score, mechanism of injury, signs of life, emergency surgery, and level I trauma center designation.
Results: We identified 271 and 1,138 adult patients with traumatic OHCA in our registry and the NTDB; 28% and 16% were transferred from another facility, respectively. Following initial resuscitation, patients transferred to a trauma center had higher in-hospital mortality than those transported directly in both our local and national cohorts (aOR: 2.27, 95%CI: 1.03-4.98, and aOR: 2.66, 95%CI: 1.35 - 5.26, respectively).
Discussion: Patients with traumatic OHCA transported directly to a trauma center may have increased survival to discharge compared to those transferred from another facility, even accounting for initial resuscitation. Further investigation should examine the impact of both physiologic and logistic factors including distance to trauma center, traffic, and weather patterns that may impact prehospital decision-making and destination selection.