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Original Research

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Interaction effect between prehospital hydration and initial cardiac rhythm in traumatic out-of-hospital cardiac arrest: a nationwide observational study

  • Dae Kon Kim1,2,3
  • Sang Do Shin2,3,4
  • Young Sun Ro2,3,4
  • Kyoung Jun Song2,3,5
  • Joo Jeong2,3,6
  • Ki Jeong Hong2,3,4,*,

1Department of Public Health Care Service, Seoul National University Bundang Hospital, 13620 Seongnam, Republic of Korea

2Laboratory of Emergency Medical Services, Seoul National University Hospital Biomedical Research Institute, 03080 Seoul, Republic of Korea

3Department Emergency Medicine, College of Medicine, Seoul National University, 03080 Seoul, Republic of Korea

4Department Emergency Medicine, Seoul National University Hospital, 03080 Seoul, Republic of Korea

5Department Emergency Medicine, Seoul Metropolitan Government Boramae Medical Center, 07061 Seoul, Republic of Korea

6Department Emergency Medicine, Seoul National University Bundang Hospital, 13620 Seongnam, Republic of Korea

DOI: 10.22514/sv.2023.128 Vol.20,Issue 2,February 2024 pp.27-37

Submitted: 15 July 2023 Accepted: 22 August 2023

Published: 08 February 2024

*Corresponding Author(s): Ki Jeong Hong E-mail:


Traumatic cardiac arrest (TCA) is different in etiology compared to medical cardiac arrest. In case of TCA, it is important to initiate early fluid resuscitation. Initial cardiac rhythm serves as an indicator of outcomes in case of cardiac arrest. We aimed to find the association between prehospital hydration and outcomes of TCA according to initial cardiac rhythm. This is a retrospective, observational, cross-sectional study. An examination was undertaken involving patients afflicted with TCA within the timeframe of 2014 to 2019. Exposure was defined to encompass prehospital hydration; interactive exposure was categorized by initial cardiac rhythm (non-shockable vs. shockable); the primary outcome was defined as good neurological status at discharge, whereas the secondary outcome was defined as survival to discharge. Multivariable logistic regression analysis was used to calculate adjusted odds ratios (AORs) with 95% confidence intervals (CIs). A comprehensive analysis was conducted on a cumulative of 20,247 patients. Rates of good neurological status and survival to discharge were 0.2% and 8.3% (non-shockable rhythm group) and 3.0% and 16.7%(shockable rhythm group), respectively. However, rates of good neurological status and survival to discharge were 0.2% and 7.9% (non-prehospital hydration group) and 0.3% and 10.0% (hydration group), respectively. Compared to the non-hydration group, the AORs for good neurological status at discharge was 1.44 (95% CI: 0.77–2.69) for the hydration group. Moreover, compared to the non-shockable rhythm group, the AORs for good neurological status at discharge was 19.74 (95% CI: 10.46–27.26) in the shockable rhythm group. The interaction analysis conducted between prehospital hydration and initial rhythm unveiled the efficacy of prehospital hydration in promoting favorable survival to discharge outcomes in the non-shockable rhythm group. Therefore, prehospital hydration is recommended for those with TCA characterized by a non-shockable rhythm before transport from the incident location.


Traumatic cardiac arrest; Prehospital hydration; Initial cardiac rhythm

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Dae Kon Kim,Sang Do Shin,Young Sun Ro,Kyoung Jun Song,Joo Jeong,Ki Jeong Hong. Interaction effect between prehospital hydration and initial cardiac rhythm in traumatic out-of-hospital cardiac arrest: a nationwide observational study. SignaVitae. 2024. 20(2);27-37.


[1] Kim DK, Kim TH, Shin SD, Ro YS, Song KJ, Hong KJ, et al. Impact of crowding in local ambulance demand on call-to-ambulance scene arrival in out-of-hospital cardiac arrest. The American Journal of Emergency Medicine. 2022; 52: 105–109.

[2] Tan N D, Daniel W, Stephen R, Louise S, Emma B. Epidemiology, management and survival outcomes of adult out-of-hospital traumatic cardiac arrest due to blunt, penetrating or burn injury. Emergency Medicine Journal. 2022; 39: 111–117.

[3] Khalifa A, Avraham JB, Kramer KZ, Bajani F, Fu CY, Pires-Menard A, et al. Surviving traumatic cardiac arrest: identification of factors associated with survival. The American Journal of Emergency Medicine. 2021; 43: 83–87.

[4] Ariss AB, Bachir R, El Sayed M. Factors associated with survival in adult patients with traumatic arrest: a retrospective cohort study from US trauma centers. BMC Emergency Medicine. 2021; 21: 77.

[5] Lee HM, Wang CT, Hsu CC, Chen KT. Algorithm to improve resuscitation outcomes in patients with traumatic out-of-hospital cardiac arrest. Cureus. 2022; 122: e23194.

[6] Houwen T, Popal Z, de Bruijn MAN, Leemeyer AR, Peters JH, Terra M, et al. Outcomes after prehospital traumatic cardiac arrest in the Netherlands: a retrospective cohort study. Injury. 2021; 52: 1117–1122.

[7] Smith JE, Rickard A, Wise D. Traumatic cardiac arrest. Journal of the Royal Society of Medicine. 2015; 108: 11–16.

[8] Shand S, Curtis K, Dinh M, Burns B. Prehospital blood transfusion in New South Wales, Australia: a retrospective cohort study. Prehospital Emergency Care. 2021; 25: 404–411.

[9] Benhamed A, Canon V, Mercier E, Heidet M, Gossiome A, Savary D, et al. Prehospital predictors for return of spontaneous circulation in traumatic cardiac arrest. Journal of Trauma and Acute Care Surgery. 2022; 92: 553–560.

[10] Clarke R, Dippenaar E. Permissive hypotension compared to fluid therapy for the management of traumatic haemorrhage: a rapid review. British Paramedic Journal. 2022; 7: 34–43.

[11] Ramesh GH, Uma JC, Farhath S. Fluid resuscitation in trauma: what are the best strategies and fluids? International Journal of Emergency Medicine. 2019; 12: 38.

[12] Rajan S, Folke F, Hansen SM, Hansen CM, Kragholm K, Gerds TA, et al. Incidence and survival outcome according to heart rhythm during resuscitation attempt in out-of-hospital cardiac arrest patients with presumed cardiac etiology. Resuscitation. 2017; 114: 157–163.

[13] Holmgren C, Bergfeldt L, Edvardsson N, Karlsson T, Lindqvist J, Silfverstolpe J, et al. Analysis of initial rhythm, witnessed status and delay to treatment among survivors of out-of-hospital cardiac arrest in Sweden. Heart. 2010; 96: 1826–1830.

[14] Tanguay-Rioux X, Grunau B, Neumar R, Tallon J, Boone R, Christenson J. Is initial rhythm in OHCA a predictor of preceding no flow time? Implications for bystander response and ECPR candidacy evaluation. Resuscitation. 2018; 128: 88–92.

[15] Cheskes S, Drennan IR. No flow time, bystander low flow time and EMS system response time: are we looking at two sides of the same coin? Resuscitation. 2021; 167: 412–413.

[16] Kim YT, Shin SD, Hong SO, Ahn KO, Ro YS, Song KJ, et al. Effect of national implementation of utstein recommendation from the global resuscitation alliance on ten steps to improve outcomes from out-of-hospital cardiac arrest: a ten-year observational study in Korea. BMJ Open. 2017; 7: e016925.

[17] Park SY, Lim D, Ryu JH, Kim YH, Choi B, Kim SH. Modification of termination of resuscitation rule with compression time interval in South Korea. Scientific Reports. 2023; 13: 1403.

[18] Kim YS, Lee SH, Lim HJ, Hong WP. Impact of COVID-19 on out-of-hospital cardiac arrest in Korea. Journal of Korean Medical Science. 2023; 38: e92.

[19] Choi DH, Ro YS, Park JH, Lee SY, Hong KJ, Song KJ, et al. Evaluation of socioeconomic position and survival after out-of-hospital cardiac arrest in Korea Using structural equation modeling. JAMA Network Open. 2023; 6: e2312722.

[20] Jung E, Ro YS, Ryu HH, Shin SD. Association of prehospital airway management technique with survival outcomes of out-of-hospital cardiac arrest patients. PLOS ONE. 2022; 17: e0269599.

[21] Choi Y, Park JH, Jeong J, Kim YJ, Song KJ, Shin SD. Extracorporeal cardiopulmonary resuscitation for adult out-of-hospital cardiac arrest patients: time-dependent propensity score-sequential matching analysis from a nationwide population-based registry. Critical Care. 2023; 27: 87.

[22] Stephan S, Jan W, Jan-Thorsten G, Ingvild T, Matthias F, Andreas B, et al. Survival after traumatic cardiac arrest is possible—a comparison of German patient-registries. BMC Emergency Medicine. 2022; 22: 158.

[23] Wongtanasarasin W, Thepchinda T, Kasirawat C, Saetiao S, Leungvorawat J, Kittivorakanchai N. Treatment outcomes of epinephrine for traumatic out-of-hospital cardiac arrest: a systematic review and meta-analysis. Journal of Emergencies, Trauma, and Shock. 2021; 14: 195–200.

[24] Lott C, Truhlář A, Alfonzo A, Barelli A, González-Salvado V, Hinkelbein J, et al. European resuscitation council guidelines 2021: cardiac arrest in special circumstances. Resuscitation. 2021; 161: 152–219.

[25] Zideman DA, Singletary EM, Borra V, Cassan P, Cimpoesu CD, De Buck E, et al. European resuscitation council guidelines 2021: first aid. Resuscitation. 2021; 161: 270–290.

[26] Savary D, Douillet D, Morin F, Drouet A, Moumned T, Metton P, et al. Acting on the potentially reversible causes of traumatic cardiac arrest: possible but not sufficient. Resuscitation. 2021; 165: 8–13.

[27] Lewis J, Perkins GD. Traumatic cardiac arrest. Current Opinion in Critical Care. 2023; 29: 162–167.

[28] Daniel O, Magnus H, Paula M, Erik O, Therese D, Malin J F. Characteristics and outcome of traumatic cardiac arrest at a level 1 trauma centre over 10 years in Sweden. Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine. 2022; 30: 54.

[29] Byrne JP, Xiong W, Gomez D, Mason S, Karanicolas P, Rizoli S, et al. Redefining “dead on arrival”: identifying the unsalvageable patient for the purpose of performance improvement. Journal of Trauma and Acute Care Surgery. 2015; 79: 850–857.

[30] Kleber C, Giesecke MT, Lindner T, Haas NP, Buschmann CT. Requirement for a structured algorithm in cardiac arrest following major trauma: epidemiology, management errors, and preventability of traumatic deaths in Berlin. Resuscitation. 2014; 85: 405–410.

[31] Australian and New Zealand Committee on Resuscitation. ANZCOR Guideline 11.10.1 Management of Cardiac Arrest due to Trauma. 2016. Available at: (12 August 2023).

[32] Evans CC, Petersen A, Meier EN, Buick JE, Schreiber M, Kannas D, et al. Prehospital traumatic cardiac arrest: management and outcomes from the resuscitation outcomes consortium epistry-trauma and PROPHET registries. Journal of Trauma and Acute Care Surgery. 2016; 81: 285–293.

[33] Keizer AA, Arkenbosch JHC, Kong VY, Hoencamp R, Bruce JL, Smith MTD, et al. Blunt and penetrating liver trauma have similar outcomes in the modern era. Scandinavian Journal of Surgery. 2021; 110: 208–213.

[34] Lee SY, Song KJ, Shin SD. Effect of implementation of cardiopulmonary resuscitation-targeted multi-tier response system on outcomes after out-of-hospital cardiac arrest: a before-and-after population-based study. Prehospital Emergency Care. 2020; 24: 220–231.

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