Neurological outcomes after traumatic cardiopulmonary arrest: a systematic review

BACKGROUND: Despite appropriate care, most patients do not survive traumatic cardiac arrest, and many survivors suffer from permanent neurological disability. The prevalence of non-dismal neurological outcomes remains unclear. OBJECTIVES: The aim of the current review is to summarize and assess the quality of reporting of the neurological outcomes in traumatic cardiac arrest survivors. DATA SOURCES: A systematic review of Embase, Medline, PubMed, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and ProQuest databases was performed from inception of the database to July 2020. STUDY ELIGIBILITY CRITERIA: Observational cohort studies that reported neurological outcomes of patients surviving traumatic cardiac arrest were included. PARTICIPANTS AND INTERVENTIONS: Patients who were resuscitated following traumatic cardiac arrest. STUDY APPRAISAL AND SYNTHESIS METHODS: The quality of the included studies was assessed using ROBINS-I (Risk of Bias in Non-Randomized Studies - of Interventions) for observational studies. RESULTS: From 4295 retrieved studies, 40 were included (n=23 644 patients). The survival rate was 9.2% (n=2168 patients). Neurological status was primarily assessed at discharge. Overall, 45.8% of the survivors had good or moderate neurological recovery, 29.0% had severe neurological disability or suffered a vegetative state, and 25.2% had missing neurological outcomes. Seventeen studies qualitatively described neurological outcomes based on patient disposition and 23 studies used standardized outcome scales. 28 studies had a serious risk of bias and 12 had moderate risk of bias. LIMITATIONS: The existing literature is characterized by inadequate outcome reporting and a high risk of bias, which limit our ability to prognosticate in this patient population. CONCLUSIONS OR IMPLICATIONS OF KEY FINDINGS: Good and moderate neurological recoveries are frequently reported in patients who survive traumatic cardiac arrest. Prospective studies focused on quality of survivorship in traumatic arrest are urgently needed. LEVEL OF EVIDENCE: Systematic review, level IV. PROSPERO REGISTRATION NUMBER: CRD42020198482.