Outcomes of odontoid fractures with associated cardiac arrest: retrospective bi-center case series and systematic literature review

Abstract

Abstract Background Odontoid fractures from high-energy trauma are associated with significant morbidity and mortality, including spinal cord injury, neurological damage, and cardiac arrest. The literature on odontoid fractures leading to cardiac arrest is limited to isolated case reports. This study aims to conduct a retrospective bi-center case series and a systematic review of existing literature. Methods We conducted a retrospective bi-center case series on patients with odontoid fractures from high-energy trauma who experienced post-traumatic cardiac arrest with return of spontaneous circulation (ROSC) after CPR from two Level 1 Trauma Centers (2008–2024). The primary outcome was in-hospital mortality; secondary outcomes included epidemiological, pre-hospital, and in-hospital data, and CT and MRI findings. Additionally, we performed a systematic literature review to summarize existing evidence. Results The study included 25 patients (mean age 71.1 ± 12.3 years, SD; 8 females). The mortality rate was 92% (23 patients). Median downtime before CPR was 5.0 min (IQR: 7.0), with CPR lasting 17.0 min (IQR: 13.0), primarily initiated by professionals (60%). All patients were quadriplegic. Type II Anderson d’Alonzo fractures were most common (88%), with all patients showing myelopathy on MRI. Only three patients (12%) underwent surgical intervention due to favorable prognosis. Our literature review identified seven case reports, with two patients surviving and one achieving full recovery. Conclusions In this case series, patients experiencing cardiac arrest after odontoid fractures exhibited high mortality rates despite comprehensive management at Level 1 trauma centers. Survivors faced significant and enduring morbidity.

Keywords

• Cervical injuries
• Spinal injuries
• Heart arrest
• Resuscitation
• Review