Prehospital Resuscitative Thoracotomy feasible and improves survival in traumatic cardiac arrest : JAMA
Researchers have found in a new study that mature, physician-led, urban prehospital system can successfully perform resuscitative thoracotomy, leading to improved survival rates for patients experiencing out-of-hospital traumatic cardiac arrest (TCA). The study highlights the importance of a well-structured emergency response system in enhancing patient outcomes.
Traumatic cardiac arrest (TCA) presents a critical challenge in trauma care, often occurring rapidly after injury before effective interventions are available. A study was done to evaluate the association of prehospital resuscitative thoracotomy with survival outcomes for Traumatic cardiac arrest. This retrospective cohort study examined all cases of prehospital resuscitative thoracotomy for Traumatic cardiac arrest in London from January 1999 to December 2019. Data were analyzed from July 2022 to July 2023.
The primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and neurological status at discharge. Results Prehospital resuscitative thoracotomy was undertaken in 601 patients with out-of-hospital Traumatic cardiac arrest.
The median (IQR) age was 25 (20-37) years; 538 (89.5%) were male and 63 (10.5%) female. A total of 529 patients (88.0%) had a penetrating mechanism of injury. Traumatic cardiac arrest occurred at a median (IQR) of 12 (6-22) minutes after the emergency call, with 491 arrests (81.7%) before the advanced trauma team’s arrival. Traumatic cardiac arrest was the result of cardiac tamponade (105 patients, 17.5%), exsanguination (418 patients, 69.6%), and exsanguination combined with cardiac tamponade (72 patients, 12.0%).
Thirty patients (5.0%) survived to hospital discharge, with a favorable neurological outcome observed in 23 survivors (76.6%). Survival varied significantly with the cause of Traumatic cardiac arrest: 22 of 105 patients (21%) with cardiac tamponade, 8 of 418 patients (1.9%) with exsanguination, and none of the 72 patients with combined or other pathologies survived. There were no survivors beyond 15 minutes of Traumatic cardiac arrest for cardiac tamponade and 5 minutes after exsanguination. Multivariable analysis revealed that the cause of Traumatic cardiac arrest (adjusted odds ratio [aOR], 21.1; 95% CI, 8.1-54.7; P < .001), duration of Traumatic cardiac arrest (aOR, 20.9; 95% CI, 4.4-100.6, P < .001), and absence of the need for internal cardiac massage (AOR, 0.2; 95% CI, 0.06-0.5; P = .001) were independently associated with survival.
Traumatic cardiac arrestoccurs soon after injury, with only a brief window available for effective intervention. This study found that resuscitative thoracotomy is feasible in a mature, physician-led, urban prehospital system and is associated with improved survival for patients with out-of-hospital Traumatic cardiac arrest, particularly when caused by cardiac tamponade, in situations where other treatment options are limited.
Reference:
Perkins ZB, Greenhalgh R, ter Avest E, et al. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. Published online February 26, 2025. doi:10.1001/jamasurg.2024.7245
