Abstract Sun1105: Trauma center vs. nearest non-trauma center: direct transport or bypass approach for out-of-hospital traumatic cardiac arrest

Abstract

Out-of-hospital traumatic cardiac arrest (TCA), caused by severe injuries such as blunt or penetrating trauma, is associated with extremely low survival rates. Around 2.7% of trauma patients experience cardiac arrest on scene, with an overall survival rate below 5%. The impact of hospital level and transport distance on TCA outcomes remains unclear. This study aimed to assess whether transport to hospitals of different levels and distances is associated with return of spontaneous circulation (ROSC), survival to admission, and 30-day survival. We conducted a retrospective study of adult TCA patients transported to emergency departments in Taoyuan City from January 2016 to December 2022. Patients were divided into three groups: those transported to a trauma center (TC), to the nearest non-trauma center (non-TC), or cross-regionally to a TC. Geographic information system (GIS) data were used to determine hospital locations and distances. Multivariable logistic regression was performed to analyze associations between transport destination and clinical outcomes. A total of 557 patients were included (TC: 190 [72 direct, 118 cross-regional]; non-TC: 367). The TC and cross-region TC groups had higher ROSC rates (30.6% and 30.5%, respectively) and lower mortality (95.8% for both) than the non-TC group (ROSC 12.0%, mortality 99.5%). Multivariable analysis showed that direct TC transport (aOR 2.91, 95% CI 1.54–5.49) and cross-regional TC transport (aOR 2.05, 95% CI 1.01–4.15) were significantly associated with better outcomes. Blunt trauma was independently associated with worse survival (aOR 0.31, 95% CI 0.08–0.78). Transport to a TC—either directly or across regions—is associated with improved survival in TCA. The current policy prioritizing the nearest hospital may lead to worse outcomes. Within 10 km, bypassing non-TCs in favor of TCs may be beneficial. Blunt trauma is linked to poorer prognosis compared to other mechanisms.