Cardiac arrest in adult patients following burn injury: a scoping review with expert recommendations on management.

BACKGROUND

Cardiac arrest following severe burn injury is rare but devastating, reflecting profound systemic compromise from hypovolemia, hypoxia, toxic exposure, or metabolic derangement. Despite recognition of these mechanisms, data on incidence, causes, and outcomes remain limited, and no burn-specific resuscitation guidance exists.

METHODS

A scoping review was performed using the Joanna Briggs Institute framework and PRISMA-ScR guidelines. MEDLINE and EMBASE were searched to August 2025 for studies describing cardiac arrest in adult burn patients. Data were thematically synthesized by mechanism and setting. A modified Delphi process with a multidisciplinary expert panel established consensus recommendations for management (agreement ≥ 85%).

RESULTS

Nineteen studies met inclusion criteria (three cohort studies, ten case series, six case reports), all observational and of low quality. Burn-associated cardiac arrest occurred both out-of-hospital-most often due to asphyxia, electrocution, or inhalation injury-and in-hospital from hypovolemia, electrolyte imbalance, or multi-organ failure. Survival to discharge ranged from 0-67%, highest in electrical injuries. The Delphi process generated ten expert recommendations emphasizing: early airway control (including front-of-neck access), 100% oxygen for suspected carbon monoxide poisoning, empirical hydroxocobalamin for enclosed-space fires, avoidance of succinylcholine after 24 h, and individualized decisions on cardiopulmonary resuscitation.

CONCLUSIONS

Burn-associated cardiac arrest remains poorly characterized with uniformly poor outcomes except in electrical injury. These findings and consensus recommendations provide a structured foundation for future research and clinical guidance.