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Pre-hospital thoracotomy: A radical resuscitation intervention come of age?

2007; Elsevier BV; Volume: 75; Issue: 3 Linguagem: Inglês

10.1016/j.resuscitation.2007.06.014

1873-1570

David Lockey, Gareth Davies,

Airway Management and Intubation Techniques

Published in this edition of the journal are two reports of pre-hospital thoracotomy which resulted in neurologically intact survivors. 1 Deakin C.D. From agonal to output: An ECG history of a successful pre-hospital thoracotomy. Resuscitation. 2007; 75: 525-529 Abstract Full Text Full Text PDF PubMed Scopus (12) Google Scholar , 2 Corral E. Silva J. Suárez R.M. Nuñez J. Cuesta C. A successful emergency thoracotomy performed in the field. Resuscitation. 2007; 75: 530-533 Abstract Full Text Full Text PDF PubMed Scopus (22) Google Scholar In-hospital emergency thoracotomy is a well established procedure which has resulted in many survivors. It is usually performed by surgeons but can be performed by emergency physicians if a suitable surgeon is not available. 3 Wise D. Davies G. Lockey D. Coats T. Hyde J. Goode P. Thoracotomy: how to do it. Emerg Med J. 2005; 22: 22-24 Crossref PubMed Scopus (86) Google Scholar It is well recognised that in penetrating trauma once cardiac arrest has occurred the chances of survival diminish rapidly without rapid surgical intervention. Several studies have demonstrated 100% mortality in patients who arrest outside hospital and are then transported to hospital for treatment. 4 Tyburski J.G. Astra L. Wilson R.F. Dente C. Steffes C. Factors affecting prognosis with penetrating wounds of the heart. J Trauma. 2000; 48: 587-590 Crossref Scopus (126) Google Scholar , 5 Esposito T.J. Jurkovich G.J. Rice C.L. et al. Reappraisal of emergency room thoracotomy in a changing environment. J Trauma. 1991; 31: 881 Crossref PubMed Scopus (105) Google Scholar , 6 Mazzorana V. Smith S.R. Morabito D.J. et al. Limited utility of emergency department thoracotomy. Am Surg. 1994; 60: 516 PubMed Google Scholar , 7 Brown S.E. Gomez G.A. Jacobson L.E. et al. Penetrating chest trauma: should indications for emergency room thoracotomy be limited?. Am Surg. 1996; 62: 530 PubMed Google Scholar With these statistics in mind the concept of pre-hospital thoracotomy performed on scene by doctors was developed by the London Helicopter Emergency Medical Service and clinicians at The Royal London Hospital. The first neurologically intact survivor was produced in 1993 8 Keogh S.P. Wilson A.W. Survival following pre-hospital arrest with on scene thoracotomy for stabbed heart. Injury. 1996; 27: 525-527 Abstract Full Text PDF Scopus (19) Google Scholar and further survivors regularly thereafter. 9 Coats T.J. Keogh S. Clark H. Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001; 50: 670-673 Crossref PubMed Scopus (100) Google Scholar , 10 Lockey D. Crewdsen K. Davies G.E. Traumatic cardiac arrest: who are the survivors?. Ann Emerg Med. 2006; 48: 240-244 Abstract Full Text Full Text PDF Scopus (173) Google Scholar , 11 Davies G. Lockey D. Establishing the radical intervention of pre-hospital thoracotomy as part of normal physician pre-hospital practice. Scand J Trauma Resusc Emerg Med. 2007; 15 ([abstract]): 106 Google Scholar Soar J. Deakin C.D. Nolan J.P. et al. European resuscitation council guidelines for resuscitation. Section 7. Cardiac arrest in special circumstances. Resuscitation. 2005; 67: S135-S170 Abstract Full Text Full Text PDF Scopus (174) Google Scholar The two reports published in this journal are from outside London (one from Hampshire UK and one from Madrid Spain). Both were victims of stab wounds to the chest.