Cardiac Arrest Prevalence in Elderly with Upper Cervical Spine Fractures Post-Minor Trauma

Overview

This retrospective study analyzed elderly patients (≥65 years) with upper cervical spine fractures after minor trauma to determine the prevalence of out-of-hospital cardiac arrest (OHCA) and identify contributing risk factors. Findings highlight a significant association between cervical spine fractures and cardiac arrest, emphasizing the need for awareness in emergency diagnostics.

Background

Emergency departments have evolved to manage complex comorbidities in an aging population, yet out-of-hospital cardiac arrest (OHCA) remains a critical challenge with low survival rates. Osteoporosis increases fracture risk, particularly in the cervical spine among the elderly after minor trauma. Cervical spine injuries can disrupt sympathetic pathways, causing cardiovascular instability and bradycardia, which may precipitate cardiac arrest. Despite this, cervical spine fractures are often overlooked as a cause of OHCA in elderly trauma patients.

Data Highlights

Key Findings

• Upper cervical spine fractures (C1 ± C2) in elderly patients after minor trauma are associated with a notable incidence of OHCA.
• Disruption of supraspinal sympathetic pathways from cervical injury leads to parasympathetic dominance causing cardiovascular instability such as bradycardia and asystole.
• Bradycardia typically develops within 3–5 days post-injury, but acute cardiac arrest can occur immediately after trauma.
• Common cardiac etiologies may be less frequent causes of OHCA in this population compared to neurogenic causes related to cervical spine injury.
• Laboratory markers including serum electrolytes and perfusion indicators differ between patients with and without OHCA, suggesting physiological changes linked to neurogenic shock.
• Emergency physicians often overlook cervical spine fractures as a cause of OHCA, risking missed diagnoses in elderly trauma patients.

Clinical Implications

Clinicians should maintain a high index of suspicion for upper cervical spine fractures in elderly patients presenting with OHCA after minor trauma, even when cardiac causes are not evident. Early identification and management of cervical spine injury-related cardiovascular instability may improve outcomes. Incorporating cervical spine assessment into emergency diagnostic protocols for elderly trauma patients could reduce missed diagnoses and guide appropriate resuscitation strategies.

Conclusion

Upper cervical spine fractures following minor trauma in elderly patients represent an important and underrecognized cause of out-of-hospital cardiac arrest. Awareness and early diagnosis are critical to optimize emergency care and improve survival in this vulnerable population.

References

1. Emergency Medicine Progress in Germany, 2023 -- Interdisciplinary Emergency Departments
2. Epidemiology of OHCA, 2022 -- Survival Rates and Outcomes
3. Cardiac vs Non-Cardiac Causes of CPA, 2021 -- Etiology Insights
4. Osteoporosis and Fracture Risk, 2020 -- Global Burden
5. Cervical Spine Injury and Cardiovascular Instability, 2019 -- Pathophysiology
6. Bradycardia Post-Cervical Spine Injury, 2022 -- Clinical Observations
7. STROBE and RECORD Guidelines, 2015 -- Observational Study Reporting