Should prehospital resuscitative thoracotomy be incorporated in advanced life support after traumatic cardiac arrest?

  • A. ChalkiasEmail author
  • T. Xanthos


The survival of traumatic cardiac arrest patients poses a challenge for Emergency Medical Services initiating advanced life support on-scene, especially with regard to having to decide immediately whether to initiate prehospital emergency thoracotomy. Although the necessity for carrying out the procedure remains a cause for debate, it can be life-saving when performed with the correct indications and approaches.


Traumatic cardiac arrest Prehospital Thoracotomy Algorithm 


Conflict of interest



  1. 1.
    Soar J, Perkins GD, Abbas G, Alfonzo A, Barelli A, Bierens JJ, Brugger H, Deakin CD, Dunning J, Georgiou M, Handley AJ, Lockey DJ, Paal P, Sandroni C, Thies KC, Zideman DA, Nolan JP. European Resuscitation Council Guidelines for Resuscitation 2010 Section 8. Cardiac arrest in special circumstances: electrolyte abnormalities, poisoning, drowning, accidental hypothermia, hyperthermia, asthma, anaphylaxis, cardiac surgery, trauma, pregnancy, electrocution. Resuscitation. 2010;81:1400–33.PubMedCrossRefGoogle Scholar
  2. 2.
    Sasson C, Rogers MA, Dahl J, Kellermann AL. Predictors of survival from out-of-hospital cardiac arrest: a systematic review and meta-analysis. Circ Cardiovasc Qual Outcomes. 2010;3:63–81.PubMedCrossRefGoogle Scholar
  3. 3.
    Zwingmann J, Mehlhorn AT, Hammer T, Bayer J, Südkamp NP, Strohm PC. Survival and neurologic outcome after traumatic out-of-hospital cardiopulmonary arrest in a pediatric and adult population: a systematic review. Crit Care. 2012;16:R117.PubMedCentralPubMedCrossRefGoogle Scholar
  4. 4.
    Athanasiou T, Krasopoulos G, Nambiar P, Coats T, Petrou M, Magee P, Uppal R. Emergency thoracotomy in the pre-hospital setting: a procedure requiring clarification. Eur J Cardiothorac Surg. 2004;26:377–86.PubMedCrossRefGoogle Scholar
  5. 5.
    Lockey D, Crewdson K, Davies G. Traumatic cardiac arrest: who are the survivors? Ann Emerg Med. 2006;48:240–4.PubMedCrossRefGoogle Scholar
  6. 6.
    Davies GE, Lockey DJ. Thirteen survivors of prehospital thoracotomy for penetrating trauma: a prehospital physician-performed resuscitation procedure that can yield good results. J Trauma. 2011;70:E75–8.PubMedCrossRefGoogle Scholar
  7. 7.
    Matsumoto H, Mashiko K, Hara Y, Kutsukata N, Sakamoto Y, Takei K, Kanemaru K, Tomita Y, Saito N, Yagi T, Tetsu S, Iida H, Masuda Y, Koami H, Yokota H. Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system. Resuscitation. 2009;80:1270–4.PubMedCrossRefGoogle Scholar
  8. 8.
    Wall MJ Jr, Pepe PE, Mattox KL. Successful roadside resuscitative thoracotomy: case report and literature review. J Trauma. 1994;36:131–4.PubMedCrossRefGoogle Scholar
  9. 9.
    Keogh SP, Wilson AW. Survival following pre-hospital arrest with on-scene thoracotomy for a stabbed heart. Injury. 1996;27:525–7.PubMedCrossRefGoogle Scholar
  10. 10.
    Craig R, Clarke K, Coats TJ. On scene thoracotomy: a case report. Resuscitation. 1999;40:45–7.PubMedCrossRefGoogle Scholar
  11. 11.
    Wright KD, Murphy K. Cardiac tamponade: a case of kitchen floor thoracotomy. Emerg Med J. 2002;19:587–8.PubMedCentralPubMedCrossRefGoogle Scholar
  12. 12.
    Corral E, Silva J, Suárez RM, Nuñez J, Cuesta C. A successful emergency thoracotomy performed in the field. Resuscitation. 2007;75:530–3.PubMedCrossRefGoogle Scholar
  13. 13.
    Mollberg NM, Wise SR, Berman K, Chowdhry S, Holevar M, Sullivan R, Vafa A. The consequences of noncompliance with guidelines for withholding or terminating resuscitation in traumatic cardiac arrest patients. J Trauma. 2011;71:997–1002.PubMedCrossRefGoogle Scholar
  14. 14.
    Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons—Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg. 2001;193:303–9.CrossRefGoogle Scholar
  15. 15.
    Asensio JA, Murray J, Demetriades D, Berne J, Cornwell E, Velmahos G, Gomez H, Berne TV. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg. 1998;186:24–34.PubMedCrossRefGoogle Scholar
  16. 16.
    Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001;50:670–3.PubMedCrossRefGoogle Scholar
  17. 17.
    Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, Gomez H, Chahwan S, Velmahos G, Cornwell EE, Belzberg H, Shoemaker W, Berne TV. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44:1073–82.PubMedCrossRefGoogle Scholar
  18. 18.
    Frezza EE, Mezghebe H. Is 30 minutes the golden period to perform emergency room thoratomy (ERT) in penetrating chest injuries? J Cardiovasc Surg (Torino). 1999;40:147–51.Google Scholar
  19. 19.
    Chalkias A. Prehospital emergency thoracotomy: when to do it? Australasian J Paramedicine. 2009;7:1.Google Scholar
  20. 20.
    Ashrafian H, Athanasiou T. Emergency prehospital on-scene thoracotomy: a novel method. Coll Antropol. 2010;34:1449–52.PubMedGoogle Scholar
  21. 21.
    Wise D, Davies G, Coats T, Lockey D, Hyde J, Good A. Emergency thoracotomy: “how to do it”. Emerg Med J. 2005;22:22–4.PubMedCentralPubMedCrossRefGoogle Scholar

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© Springer-Verlag Berlin Heidelberg 2013

Authors and Affiliations

  1. 1.MSc “Cardiopulmonary Resuscitation”, Medical SchoolNational and Kapodistrian University of AthensAthensGreece

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