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TOPLINE:

Prehospital resuscitative thoracotomy was feasible for traumatic cardiac arrest (TCA) in a mature, physician-led, urban system and was associated with improved survival, particularly when performed within minutes of TCA onset and in cases of cardiac tamponade.

METHODOLOGY:

• TCA is a major challenge in trauma care and occurs soon after injury, often before interventions can be effectively implemented.
• Researchers conducted a retrospective cohort study to evaluate survival outcomes among 601 patients who experienced TCA and underwent prehospital resuscitative thoracotomy (median age, 25 years; 89.5% men) performed by London's Air Ambulance team during 1999-2019.
• The primary outcome was survival to hospital discharge.

TAKEAWAY:

• Overall, 5% of patients survived until hospital discharge, and 73.4% of those who did not were pronounced dead at the scene.
• The underlying causes of TCA included cardiac tamponade (17.6%), exsanguination (70%), or both (12.1%).
• The risk factors associated with survival to hospital discharge were the cause of TCA (adjusted odds ratio [aOR], 21.1; P < .001), duration of TCA (aOR, 20.9; P < .001), and absence of the need for internal cardiac massage (aOR, 0.2; P = .001).
• The highest survival rate was observed when TCA lasted under 1 minute. No patients with TCA due to cardiac tamponade survived beyond 15 minutes and no patients with TCA due to exsanguination survived beyond 5 minutes.

IN PRACTICE:

"The findings emphasise the importance of rapid identification and treatment of reversible causes of TCA and highlight the need for effective prehospital interventions to achieve this," the authors wrote.

"It is often only in hindsight that cause of arrest (tamponade vs exsanguination) can be determined, which then really puts an emphasis on mechanism, timing, a meaningful heart rhythm, and signs of life as the defining factor as to allocation of [the resuscitative thoracotomy] intervention," experts wrote in an invited commentary.

SOURCE:

This study was led by Zane B. Perkins, PhD, Queen Mary University of London, London, United Kingdom, and was published online on February 26, 2025, in JAMA Surgery. Three authors from the University of Pittsburgh in Pennsylvania wrote the invited commentary related to this study.

LIMITATIONS:

This retrospective study relied on data recorded during TCA by attending clinical teams, leading to inevitable gaps in data. Treatment options evolved over the 21-year period during which the data were collected, potentially affecting patient selection and outcomes. Patients who met specific indications received resuscitative thoracotomy, which may have introduced selection bias.

DISCLOSURES:

One author reported serving on the medical advisory board for or having equity in Certus Critical Care outside the submitted work. No other disclosures were reported.

This article was created using several editorial tools, including AI, as part of the process. Human editors reviewed this content before publication.