2025/12/01 by Christopher Ennis, Jacob Tant, Brian Burns +5 · 1 voice
Medicine · #Cardiac Arrest and Resuscitation #Pleural and Pulmonary Diseases #Trauma Management and Diagnosis
paper · doi:10.1111/1742-6723.70186
openalex publication_date 2025/12/01 · openalex created_date 2025/12/09 · openalex updated_date 2026/07/28
INTRODUCTION: For patients in traumatic cardiac arrest (TCA) on scene, the brevity of the window for intervention means that hospital transfer is usually futile, and so pre-hospital resuscitative thoracotomy (PHRT) may represent the best chance of survival. METHODS: In this case series we describe all cases of PHRT undertaken from 1st Jan 2013 until 31st December 2024, in NSW, Australia by physician-paramedic teams. Data were abstracted by two operators, with adjudication by a third. Patients were excluded if RT was commenced in hospital. RESULTS: A total of 35,146 missions were conducted in our service over the study period; 14,072 were pre-hospital taskings. 34 patients underwent PHRT. 31 patients (91%, 95% CI 76%-98%) were male, and 32 cases (95%, 95% CI 79%-99%) were due to penetrating trauma. Electrical cardiac activity was the commonest sign of life, occurring in 25 patients (74%, 95% CI 55%-86%). 12 patients (35%, 95% CI 20%-54%) had pericardial effusions, and in 10 (29%, 95% CI 16%-48%) this was due to a single cardiac laceration. Five patients (15%, 95% CI 6%-32%) survived for more than 24 h in hospital, and 2 (6%, 95% CI 1%-21%) were discharged neurologically intact. Despite central stab wounds, the survivors had exsanguinated from extra-thoracic trauma, with no evidence of intrathoracic injury. CONCLUSION: Our study demonstrates that even in low-volume settings, PHRT can achieve neurologically intact unexpected survivors.