The Dismal Outcomes of Prehospital Thoracotomy

It doesn't turn out the way it does on television.

This is a fun little article I stumbled upon from linked from the St.Emlyn’s social account looking at two decades worth of prehospital resuscitative thoracotomy in trauma. Resuscitative thoracotomy is a heroic procedure, rarely performed in U.S. emergency departments outside of dedicated trauma centers, let alone in the prehospital setting. However, a few retrieval services deploy physician-led teams capable of attempting this procedure in the field.

In the 601 patients with out-of-hospital traumatic cardiac arrest recorded in their registry, the London folks observed this:

Neurologically intact survival (CPC 1 or 2) was 22 of 105 with cardiac tamponade, 8 of 418 with exsanguination, and 0 of 72 with combined or other pathologies.

These data are likely somewhat generalizable within prehospital settings, and then somewhat further on to non-trauma hospital centers. The key insight here reinforces what is already mostly known: this is nearly always a futile procedure, but where intervention is feasible and indicated is when TCA occurs right in front of you as a result of cardiac tamponade.