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


CONCLUSIONS
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.
Coats
T J
TJ
Academic Unit of Accident and Emergency, St. Bartholomew's and the Royal London School of Medicine, Queen Mary and Westfield College, University of London, London, United Kingdom. t.j.coats@mds.qmw.ac.uk
Keogh
S
S
Clark
H
H
Neal
M
M
D000293:Adolescent; D000328:Adult; D017677:Age Distribution; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D000401:Aircraft; D000465:Algorithms; D002648:Child; D003663:Decision Trees; D004632:Emergency Medical Services / Q000379:methods*; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000401:mortality / Q000628:therapy*; D006801:Humans; D008131:London / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D016019:Survival Analysis; D013898:Thoracic Injuries / Q000150:complications*; D013908:Thoracotomy / Q000379:methods*; D013997:Time Factors; D016896:Treatment Outcome; D014950:Wounds, Penetrating / Q000150:complications*