Pre-Hospital Resuscitative Thoracotomy Performed in New South Wales, Australia: A Case-Series

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.

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.

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.

Our study demonstrates that even in low-volume settings, PHRT can achieve neurologically intact unexpected survivors.