Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series.

Abstract

OBJECTIVE:

The purpose of this study is to present the rationale for an algorithm that describes the place of resuscitative thoracotomy in the prehospital management of a patient with penetrating chest injury, and to review a 6-year experience using this algorithm.

METHODS:

This study was a retrospective review of all cases where a prehospital thoracotomy was performed by the medical teams of the London Helicopter Emergency Medical Service.

RESULTS:

Thirty-nine prehospital thoracotomies were performed. Four (10%) patients survived, one with long-term disability. Factors associated with survival were stab wound, single cardiac wound, cardiac tamponade, and loss of pulse in the presence of an experienced prehospital doctor.

CONCLUSION:

Current evidence suggests that patients who suffer a cardiac arrest more than 10 minutes away from emergency room thoracotomy are very unlikely to survive. Prehospital thoracotomy is associated with a small number of survivors. This intervention should be considered if there is an appropriately experienced, trained, and equipped doctor present, who is acting within a trauma system with ongoing training and quality assurance.

• Authors: T J Coats, S Keogh, H Clark, M Neal
• Journal: The Journal of trauma (J Trauma) Vol. 50 Issue 4 Pg. 670-3 (Apr 2001) ISSN: 0022-5282 [Print] United States
• PMID: 11303162 (Publication Type: Journal Article)

Topics

• Adolescent
• Adult
• Age Distribution
• Aged
• Aged, 80 and over
• Air Ambulances
• Aircraft
• Algorithms
• Child
• Decision Trees
• Emergency Medical Services (methods)
• Female
• Heart Arrest (etiology, mortality, therapy)
• Humans
• London (epidemiology)
• Male
• Middle Aged
• Resuscitation (methods)
• Retrospective Studies
• Survival Analysis
• Thoracic Injuries (complications)
• Thoracotomy (methods)
• Time Factors
• Treatment Outcome
• Wounds, Penetrating (complications)