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Introduction Patients with traumatic out-of-hospital cardiac arrest (OHCA) continue to demonstrate poor outcomes. Although some prehospital studies suggest transfusion is associated with better outcomes, the association of blood transfusion at the emergency department (ED) with sustained return of spontaneous circulation (ROSC) in patients in traumatic OHCA remains unclear.Methods This multicentre retrospective study included adult patients with blunt traumatic OHCA who were brought to the National Taiwan University Hospital and affiliated institutions from January 2016 to August 2023. Patients under 18 years old and those who suffered from penetrating injury, burn, hanging or other non-blunt injury were excluded. Blood transfusion was defined as any blood product administration during the ED stay. The outcomes were sustained and any ROSC. The variables analysed included demographics and resuscitation factors. Multivariable logistic regression was conducted, reporting results as adjusted ORs (aORs) with 95% CI.Results This study included 442 patients, of whom 64 (14.5%) achieved sustained ROSC, whereas 378 (85.5%) did not. A total of 164 (37.1%) patients received blood transfusions. Among them, 2.4% patients survived to be discharged. Blood transfusion was found to be independently associated with sustained ROSC (aOR 4.58, 95% CI 2.45 to 8.58, p<0.001) whereas thoracostomy was associated with a significantly decreased likelihood of sustained ROSC (aOR 0.26, 95% CI 0.13 to 0.51, p<0.001). Factors independently associated with an increased likelihood of any ROSC included blood transfusion, witnessed arrest, arrest en route, while thoracostomy was associated with decreased likelihood of any ROSC.Conclusions Blood transfusion in the ED is associated with increased likelihood of sustained ROSC for patients with blunt traumatic OHCA, potentially serving as a bridge to definitive treatment. However, subsequent cost-effectiveness analysis should be considered for better resource allocation.