Survival after Resuscitative Thoracotomy in the Emergency Department: An Analysis of 487 Trauma Patients with Prehospital Cardiopulmonary Resuscitation

Abstract

Background: The association between prehospital cardiopulmonary resuscitation (CPR) duration and outcomes after emergency department resuscitative thoracotomy (RT) remains uncertain. We evaluated whether EMS-derived time-stamped prehospital CPR duration was associated with survival and neurologic outcomes after RT. Study Design: Single-institution retrospective cohort study of adults undergoing RT after prehospital traumatic cardiac arrest between 2016 and 2023. Prehospital CPR duration was defined as the interval from EMS recognition of cardiac arrest to hospital arrival. The primary outcome was survival to discharge; secondary outcomes were 24-hour survival, return of spontaneous circulation (ROSC), and neurologic status at discharge. Results: Among 487 patients (223 blunt, 264 penetrating; median age 35 years [IQR 28–51]; 87.7% male), median prehospital CPR duration was 15 minutes for both blunt and penetrating trauma. One blunt trauma patient (0.4%) survived after 6 minutes of CPR with severe neurologic disability (CPC 4); no blunt trauma patient achieved favorable neurologic outcome. Six penetrating trauma patients (2.3%) survived with good neurologic outcomes (CPC 1–2), all after prehospital CPR durations of 10 minutes or less. Increasing CPR duration was associated with increasing mortality and decreasing ROSC (Ptrend<0.01). Conclusions: Longer prehospital CPR duration was associated with progressively worse outcomes after RT. No blunt trauma patient requiring prehospital CPR survived with favorable neurologic function, whereas all neurologically intact survivors after penetrating trauma underwent 10 minutes or less of prehospital CPR. These findings provide additional evidence to inform future studies evaluating patient selection for RT.