Thirteen Survivors of Prehospital Thoracotomy for Penetrating Trauma: A Prehospital Physician-Performed Resuscitation Procedure That Can Yield Good Results
- 1 May 2011
- journal article
- research article
- Published by Ovid Technologies (Wolters Kluwer Health) in Journal Of Trauma-Injury Infection and Critical Care
- Vol. 70 (5), E75-E78
- https://doi.org/10.1097/ta.0b013e3181f6f72f
Abstract
Prehospital cardiac arrest associated with trauma almost always results in death. A case of survival after prehospital thoracotomy was published in 1994 and several others have followed. This article describes the result of prehospital thoracotomy in a physician-led system for patients with stab wounds to the chest who suffered cardiac arrest on scene. A 15-year retrospective prehospital trauma database review identified victims of stab wounds to the chest who suffered cardiac arrest on scene and had thoracotomy performed according to local standard operating procedures. Overall, 71 patients met inclusion criteria. Thirteen patients (18%) survived to hospital discharge. Neurologic outcome was good in 11 patients and poor in 2. Presenting cardiac rhythm was asystole in four patients, pulseless electrical activity in five, and unrecorded in the remaining four. All survivors had cardiac tamponade. The medical team was present at the time of cardiac arrest for six survivors (good neurologic outcome): arrived in the first 5 minutes after arrest in three patients (all good neurologic outcome), arrived 5 minutes to 10 minutes after arrest in two patients (one poor neurologic outcome), and in one patient (poor neurologic outcome) the period was unknown. Of the survivors, seven thoracotomies were performed by emergency physicians and six by anesthesiologists. Prehospital thoracotomy is a well-established procedure in this physician-led prehospital service. Results from this and other similar systems suggest that when performed for the subgroup of patients described, significant numbers of survivors with good neurologic outcome can be expected.Keywords
This publication has 25 references indexed in Scilit:
- Is the prevalence of deliberate penetrating trauma increasing in London? Experiences of an urban pre-hospital trauma serviceInjury, 2009
- Traumatic Cardiac Arrest: Who Are the Survivors?Annals of Emergency Medicine, 2006
- Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes.World Journal of Emergency Surgery, 2006
- Emergency thoracotomy: "how to do it"Emergency Medicine Journal, 2004
- Guidelines for Withholding or Termination of Resuscitation in Prehospital Traumatic Cardiopulmonary Arrest: Joint Position Statement of the National Association of EMS Physicians and the American College of Surgeons Committee on TraumaJournal of the American College of Surgeons, 2003
- Prehospital Resuscitative Thoracotomy for Cardiac Arrest after Penetrating Trauma: Rationale and Case SeriesThe Journal of Trauma and Acute Care Surgery, 2001
- Factors Affecting Prognosis with Penetrating Wounds of the HeartJournal Of Trauma-Injury Infection and Critical Care, 2000
- Survival following pre-hospital arrest with on-scene thoracotomy for a stabbed heartInjury, 1996
- SUCCESSFUL ROADSIDE RESUSCITATIVE THORACOTOMYThe Journal of Trauma and Acute Care Surgery, 1994
- Reappraisal of Emergency Room Thoracotomy in a Changing EnvironmentThe Journal of Trauma and Acute Care Surgery, 1991