Evaluation of out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma; Three years after our first report

Waes, Oscar J.F. Van; Leemeyer, Anna-Marie R.; Kooij, Fabian O.; Hoogerwerf, Nico; Vledder, Mark G. van

doi:10.1016/j.injury.2019.08.032

Cited by 4 publications

(4 citation statements)

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“…The most recent ERC guidelines do provide some guidance and we believe these should be adapted to fit individual EMS systems; if reversible causes for TCA can be promptly and effectively treated on-scene, these should be looked for and treated accordingly as an integral part of resuscitation. Examples include the immediate treatment of cardiac tamponade by resuscitative thoracotomy or needle/finger thoracostomy in tensionpneumothorax [49][50][51]. If the level of training of the emergency care provider does not allow for such procedures or if the injuries leading to cardiac arrest cannot be adequately addressed on-scene (for instance hypovolemia due to penetrating truncal injury), no time should be wasted on any on-scene interventions and the patient should be transported to the nearest trauma center without delay.…”

Section: Discussionmentioning

confidence: 99%

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Vianen

Lieshout

Maissan

et al. 2022

Eur J Trauma Emerg Surg

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Background Circulatory arrest after trauma is a life-threatening situation that mandates urgent action. The aims of this systematic review and meta-analysis on prehospital traumatic cardiac arrest (TCA) were to provide an updated pooled mortality rate for prehospital TCA, to investigate the impact of the time of patient inclusion and the type of prehospital trauma system on TCA mortality rates and neurological outcome, and to investigate which pre- and intra-arrest factors are prognostic for prehospital TCA mortality. Methods This review was conducted in accordance with the PRISMA and CHARMS guidelines. Databases were searched for primary studies published about prehospital TCA patients (1995–2020). Studies were divided into various EMS-system categories. Data were analyzed using MedCalc, Review Manager, Microsoft Excel, and Shinyapps Meta Power Calculator software. Results Thirty-six studies involving 51.722 patients were included. Overall mortality for TCA was 96.2% and a favorable neurological outcome was seen in 43.5% of the survivors. Mortality rates were 97.2% in studies including prehospital deaths and 92.3% in studies excluding prehospital deaths. Favorable neurological outcome rates were 35.8% in studies including prehospital deaths and 49.5% in studies excluding prehospital deaths. Mortality rates were 97.6% if no physician was available at the prehospital scene and 93.9% if a physician was available. Favorable neurological outcome rates were 57.0% if no physician was available at the prehospital scene and 38.0% if a physician was available. Only non-shockable rhythm was associated with a higher mortality (RR 1.12, p = 0.06). Conclusion Approximately 1 in 20 patients with prehospital TCA will survive; about 40% of survivors have favorable neurological outcome.

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Section: Discussionmentioning

confidence: 99%

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Vianen

Lieshout

Maissan

et al. 2022

Eur J Trauma Emerg Surg

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“…It has been suggested that RTs need to be performed within 30 min of the injury to have a better chance of survival, and these distances and times make this challenging despite rapid dispatch of the HEM service [ 20 ]. There does however appear to be a learning curve and it may be that if numbers increase that long term survivors may be seen [ 21 ]. It is also encouraging that, despite the distances to hospital and longer run times to incidents, patients are gaining a ROSC and therefore access to surgery to give them the chance of survival, suggesting that it is worth performing.…”

Section: Discussionmentioning

confidence: 99%

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma

Almond

Morton

O’Meara

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment. Methods The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant. Results Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs. Conclusion Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.

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“…Several studies have shown that a "scoop and run" approach is preferable in patients with penetrating injury, especially when in hemorrhagic shock (13)(14)(15). An exception to this may be the pulseless patients with cardiac tamponade due to a stab wound, as swift on-scene thoracotomy and decompression of the pericardium can result in ROSC quite successfully (16,17). For patients with TCA after blunt trauma it is much more difficult to decide which strategy is best, as different injuries may dictate different approaches with regard to on-scene procedures and time.…”

Section: Discussionmentioning

confidence: 99%

Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study

Houwen

Popal

Bruijn

et al. 2021

Injury

Self Cite

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Evaluation of out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma; Three years after our first report

Cited by 4 publications

References 1 publication

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

Prehospital traumatic cardiac arrest: a systematic review and meta-analysis

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma

Outcomes after Prehospital Traumatic Cardiac Arrest in the Netherlands: a Retrospective Cohort Study

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