Perkins Zane B, Greenhalgh Robert, Ter Avest Ewoud, Aziz Shadman, Whitehouse Andrew, Read Steve, Foster Liz, Chege Frank, Henry Christine, Carden Richard, Kocierz Laura, Davies Gareth, Hurst Tom, Lendrum Robbie, Thomas Stephen H, Lockey David J, Christian Michael D
London's Air Ambulance, London, United Kingdom.
Centre for Trauma Sciences, Queen Mary University of London, London, United Kingdom.
JAMA Surg. 2025 Feb 26;160(4):432-40. doi: 10.1001/jamasurg.2024.7245.
Traumatic cardiac arrest (TCA) presents a critical challenge in trauma care, often occurring rapidly after injury before effective interventions are available.
To evaluate the association of prehospital resuscitative thoracotomy with survival outcomes for TCA.
DESIGN, SETTING, AND PARTICIPANTS: This retrospective cohort study examined all cases of prehospital resuscitative thoracotomy for TCA in London from January 1999 to December 2019. Data were analyzed from July 2022 to July 2023.
Prehospital resuscitative thoracotomy for TCA.
The primary outcome was survival to hospital discharge. Secondary outcomes included survival to hospital admission and neurological status at discharge.
Prehospital resuscitative thoracotomy was undertaken in 601 patients with out-of-hospital TCA. The median (IQR) age was 25 (20-37) years; 538 (89.5%) were male and 63 (10.5%) female. A total of 529 patients (88.0%) had a penetrating mechanism of injury. TCA occurred at a median (IQR) of 12 (6-22) minutes after the emergency call, with 491 arrests (81.7%) before the advanced trauma team's arrival. TCA was the result of cardiac tamponade (105 patients, 17.5%), exsanguination (418 patients, 69.6%), and exsanguination combined with cardiac tamponade (72 patients, 12.0%). Thirty patients (5.0%) survived to hospital discharge, with a favorable neurological outcome observed in 23 survivors (76.6%). Survival varied significantly with the cause of TCA: 22 of 105 patients (21%) with cardiac tamponade, 8 of 418 patients (1.9%) with exsanguination, and none of the 72 patients with combined or other pathologies survived. There were no survivors beyond 15 minutes of TCA for cardiac tamponade and 5 minutes after exsanguination. Multivariable analysis revealed that the cause of TCA (adjusted odds ratio [aOR], 21.1; 95% CI, 8.1-54.7; P < .001), duration of TCA (aOR, 20.9; 95% CI, 4.4-100.6, P < .001), and absence of the need for internal cardiac massage (AOR, 0.2; 95% CI, 0.06-0.5; P = .001) were independently associated with survival.
TCA occurs soon after injury, with only a brief window available for effective intervention. This study found that resuscitative thoracotomy is feasible in a mature, physician-led, urban prehospital system and is associated with improved survival for patients with out-of-hospital TCA, particularly when caused by cardiac tamponade, in situations where other treatment options are limited.
创伤性心脏骤停（TCA）是创伤护理中的一项严峻挑战，常在受伤后迅速发生，此时尚无有效的干预措施。
评估院前复苏性开胸手术与TCA患者生存结局的相关性。
设计、地点和参与者：这项回顾性队列研究调查了1999年1月至2019年12月在伦敦发生的所有院前TCA复苏性开胸手术病例。数据于2022年7月至2023年7月进行分析。
院前TCA复苏性开胸手术。
主要结局是存活至出院。次要结局包括存活至入院以及出院时的神经状态。
601例院外TCA患者接受了院前复苏性开胸手术。中位（四分位间距）年龄为25（20 - 37）岁；538例（89.5%）为男性，63例（10.5%）为女性。共有529例患者（88.0%）有穿透性损伤机制。TCA发生在紧急呼叫后的中位（四分位间距）12（6 - 22）分钟，其中491例心脏骤停（81.7%）发生在高级创伤团队到达之前。TCA的原因是心脏压塞（105例患者，17.5%）、失血（418例患者，69.6%）以及失血合并心脏压塞（72例患者，12.0%）。30例患者（5.0%）存活至出院，23例幸存者（76.6%）神经功能结局良好。TCA的原因导致的生存率差异显著：105例心脏压塞患者中有22例（21%）存活，418例失血患者中有8例（1.9%）存活，72例合并或其他病理情况的患者无一人存活。心脏压塞导致的TCA在15分钟后以及失血导致的TCA在5分钟后均无幸存者。多变量分析显示，TCA的原因（调整后的比值比[aOR]，21.1；95%置信区间[CI]，8.1 - 54.7；P < .001）、TCA持续时间（aOR，20.9；95% CI，4.4 - 100.6，P < .001）以及无需进行心脏内按摩（AOR，0.2；95% CI，0.06 - 0.5；P = .001）与生存独立相关。
TCA在受伤后很快发生，仅有短暂的有效干预窗口期。本研究发现，在成熟的、由医生主导的城市院前系统中，复苏性开胸手术是可行的，并且与院外TCA患者生存率的提高相关，尤其是在心脏压塞导致的TCA且其他治疗选择有限的情况下。
