title: Prehospital thoracostomy in patients with traumatic circulatory arrest: results from a physician-staffed Helicopter Emergency Medical Service.
abstract: OBJECTIVE
  Until recently, traumatic cardiac arrest (tCA) was believed to be associated with high mortality and low survival rates. New data suggest better outcomes. The most common error in tCA management is failing to treat a tension pneumothorax (TP). In the prehospital setting, we prefer thoracostomies for decompressing a potential TP in tCA cases; however, interventions can only be recommended with adequate information on their results. Therefore, we reviewed the results of thoracostomies performed by our Helicopter Emergency Medical Service.
  
  
  METHODS
  Our Helicopter Emergency Medical Service database was reviewed for all patients who underwent a single or a bilateral prehospital thoracostomy in tCA. We evaluated the incidence of TP, the return of circulation in tCA, the incidence of infections, the incidence of sharps injuries and patient survival.
  
  
  RESULTS
  A total of 267 thoracostomies were performed in 144 tCA patients. Thoracic decompression was performed to rule out TP. TP was identified in 14 patients; the incidence of TP in tCA was 9.7%. Two of the tCA patients survived and were discharged from the hospital; neither had clinical signs of TP. No infections or sharps injuries were observed.
  
  
  CONCLUSIONS
  The outcomes of patients with tCA who underwent prehospital thoracostomy were poor in our group. The early identification of TP and strict algorithm adherence in tCA may improve outcomes. In the future, to reduce the risk of unnecessary thoracic interventions in tCA, ultrasound examination may be useful to identify TP before thoracic decompression.
authors.affiliation: Departments of aTrauma Surgery bAnaesthesiology cHelicopter Emergency Medical Service, Radboud University Medical Center Nijmegen, Nijmegen, The Netherlands.
authors.forename: Joost
authors.initials: J
authors.lastname: Peters
authors.forename: Rein
authors.initials: R
authors.lastname: Ketelaars
authors.forename: Bas
authors.initials: B
authors.lastname: van Wageningen
authors.forename: Jan
authors.initials: J
authors.lastname: Biert
authors.forename: Nico
authors.initials: N
authors.lastname: Hoogerwerf
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017732:Air Ambulances; D002648:Child; D002675:Child, Preschool; D004632:Emergency Medical Services; D005260:Female; D006323:Heart Arrest / Q000209:etiology / Q000628:therapy*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011030:Pneumothorax / Q000209:etiology / Q000628:therapy; D013907:Thoracostomy / Q000379:methods; D016896:Treatment Outcome; D014947:Wounds and Injuries / Q000150:complications / Q000628:therapy*; D055815:Young Adult