title: Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system.
abstract: OBJECTIVE
  We investigated whether emergency thoracotomy (ET) performed in pre-hospital settings contributed to saving the lives of blunt trauma patients with impending or recent cardiac arrest.
  
  
  METHODS
  Eighty-one consecutive cardiac arrest patients with blunt trauma were performed ET before or after arrival at the emergency department (ED). These were reviewed retrospectively and were classified into the following three groups: (1) an emergency field thoracotomy was performed (EFT group, n=34); (2) a doctor dispatched to the scene, but the thoracotomy was performed in the ED (EDT-a group, n=10); and (3) no doctor dispatched to the scene, and the thoracotomy was performed in the ED (EDT-b group, n=37). The patients in the EFT and EDT-a groups were managed within the Japanese helicopter emergency medical service system with a doctor dispatched to the scene.
  
  
  RESULTS
  The time between the arrival of the EMT at the scene and the start of the thoracotomy was significantly shorter in the EFT group than in the EDT-b group (19.2+/-7.9 min vs. 30.7+/-6.8 min, p<0.001). In the EFT group, the "ICU admission" rate was significantly higher among the patients who experienced cardiac arrest after the EMT arrival than among the patients who experienced cardiac arrest before the EMT arrival (70% vs. 8%, p=0.001). Unfortunately, however, there were no survivors in this series.
  
  
  CONCLUSIONS
  These findings indicate that "early access" to a doctor's expertise and the performance of an "emergency field thoracotomy" might be two important factors for improving the possibility of saving the lives of blunt trauma patients with impending or recent cardiac arrest.
authors.affiliation: Shock and Trauma Center, Chiba Hokusoh Hospital, Nippon Medical School, Inba, Chiba, Japan. hmatsu@nms.ac.jp
authors.forename: Hisashi
authors.initials: H
authors.lastname: Matsumoto
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Mashiko
authors.forename: Yoshiaki
authors.initials: Y
authors.lastname: Hara
authors.forename: Noriyoshi
authors.initials: N
authors.lastname: Kutsukata
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Sakamoto
authors.forename: Kenkichi
authors.initials: K
authors.lastname: Takei
authors.forename: Katsuhiro
authors.initials: K
authors.lastname: Kanemaru
authors.forename: Yoshiteru
authors.initials: Y
authors.lastname: Tomita
authors.forename: Nobuyuki
authors.initials: N
authors.lastname: Saito
authors.forename: Takanori
authors.initials: T
authors.lastname: Yagi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Tetsu
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Iida
authors.forename: Yukiko
authors.initials: Y
authors.lastname: Masuda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Koami
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yokota
mesh_terms: D000328:Adult; D017732:Air Ambulances; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D002983:Clinical Competence; D004632:Emergency Medical Services / Q000458:organization & administration*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000453:epidemiology / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods* / Q000451:nursing; D013997:Time Factors; D014949:Wounds, Nonpenetrating / Q000453:epidemiology / Q000601:surgery*