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

J Trauma. 2001 Apr;50(4):670-3. doi: 10.1097/00005373-200104000-00012.


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.

MeSH terms

  • Adolescent
  • Adult
  • Age Distribution
  • Aged
  • Aged, 80 and over
  • Air Ambulances
  • Aircraft
  • Algorithms*
  • Child
  • Decision Trees*
  • Emergency Medical Services / methods*
  • Female
  • Heart Arrest / etiology*
  • Heart Arrest / mortality
  • Heart Arrest / 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*