von Vopelius-Feldt Johannes, Persaud Anthony, Jones Sasha, Drennan Ian, Cheskes Sheldon
Department of Medicine, University of Toronto, ON, Canada.
Li Ka Shing Knowledge Institute, St. Michael's Hospital, Toronto, ON, Canada.
Resusc Plus. 2025 Jun 21;25:101012. doi: 10.1016/j.resplu.2025.101012. eCollection 2025 Sep.
Trauma is an important cause of death worldwide, and the majority of deaths from trauma occur in the prehospital setting. The presence of hemothorax contributes to this mortality and is most frequently treated with needle thoracostomies, despite concerns about the effectiveness of this intervention. We present the results of an autopsy series of prehospital traumatic cardiac arrest, describing the frequency of hemothorax in this population and the estimated failure rate of needle thoracostomies.
We used basic demographic data from Emergency Medical Services (EMS) records covering a mixed urban/suburban area in Ontario, Canada, to identify corresponding coroner's reports of cases of prehospital traumatic cardiac arrest. Demographics, injury details, presence and size of hemothorax and prehospital interventions were extracted.
Over a 5-year study period, we successfully identified 172 cases of prehospital traumatic cardiac arrest where resuscitation was provided on scene by paramedics. There was a predominantly blunt mechanism of injury (66%) and 96% of patients were in cardiac arrest on EMS arrival. The overall incidence of traumatic hemothorax was 70%. Needle thoracostomies were performed in 40 cases (23%) of traumatic cardiac arrest. Needle thoracostomy failed to decompress a massive hemothorax in 14 out of 33 cases (42%).
We identified a high incidence of hemothorax in traumatic cardiac arrest and a high failure rate of needle thoracostomies for decompression of massive hemothorax. Further research is required to explore the feasibility and potential benefits of finger thoracostomy in prehospital traumatic cardiac arrest.
创伤是全球范围内重要的死亡原因，大多数创伤死亡发生在院前环境。血胸的存在导致了这种死亡率，尽管对这种干预措施的有效性存在担忧，但血胸最常通过针胸造口术进行治疗。我们展示了一系列院前创伤性心脏骤停尸检的结果，描述了该人群血胸的发生率以及针胸造口术的估计失败率。
我们使用了来自加拿大安大略省一个城乡混合区域的紧急医疗服务（EMS）记录中的基本人口统计学数据，以确定相应的验尸官关于院前创伤性心脏骤停病例的报告。提取了人口统计学、损伤细节、血胸的存在及大小以及院前干预措施。
在为期5年的研究期间，我们成功识别出172例院前创伤性心脏骤停病例，这些病例由护理人员在现场进行了复苏。损伤机制主要为钝性伤（66%），96%的患者在EMS到达时已处于心脏骤停状态。创伤性血胸的总体发生率为70%。在40例（23%）创伤性心脏骤停病例中进行了针胸造口术。在33例中有14例（42%）针胸造口术未能解除大量血胸。
我们发现创伤性心脏骤停中血胸的发生率很高，且针胸造口术解除大量血胸的失败率很高。需要进一步研究以探讨手指胸造口术在院前创伤性心脏骤停中的可行性和潜在益处。
