Journal Review in Trauma Surgery: Getting to the Heart of the Problem - Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest

In resuscitative trauma surgery every second counts. Can time and lives be saved by moving interventions closer to the point of injury? In this episode, we discuss a recent journal article on prehospital resuscitative thoracotomy as a treatment for traumatic cardiac arrest. Opening the chest on the street, who should do it, why should we do it, and for whom?

• Hosts:

1. Mr Prashanth Ramaraj. General Surgery trainee, Edinburgh rotation. @LonTraumaSchool
2. Dr Roisin Kelly. Major Trauma Junior Clinical Fellow, Royal London Hospital.
3. Mr Max Marsden. Resuscitative Major Trauma Fellow, Royal London Hospital. @maxmarsden83
4. Mr Christopher Aylwin. Consultant Trauma & Vascular Surgeon, Royal London Hospital and Co-Programme Director MSc Trauma Sciences at Queen Mary University of London. @cjaylwin
5. Mr Zane Perkins. Consultant Trauma & UGI Surgeon, Royal London Hospital and Prehospital Surgeon at London’s Air Ambulance. @ZBPerkins

• Learning objectives:

A) To be aware of the steps of a resuscitative thoracotomy (RT)
B) To understand the rational for prehospital (PH) trauma interventions.
C) To understand the timelines required to optimise success in PH RT.
D) To be familiar with the training governance for clinicians undertaking PH RT.
E) To recognise that PH RT is predominantly an intervention for cardiac tamponade.
F) To understand the contexts in which PH RT might be successful as a standardised intervention.

• References:

1. Perkins ZB, Greenhalgh R, Ter Avest E, Aziz S, Whitehouse A, Read S, Foster L, Chege F, Henry C, Carden R, Kocierz L, Davies G, Hurst T, Lendrum R, Thomas SH, Lockey DJ, Christian MD. Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest. JAMA Surg. 2025 Feb 26;160(4):432–40. doi: 10.1001/jamasurg.2024.7245. PMID: 40009367; PMCID: PMC11866073. https://pubmed.ncbi.nlm.nih.gov/40009367/
2. ter Avest, E., Kocierz, L., Alvarez, C. et al. Improving decision-making for prehospital Resuscitative Thoracotomy in traumatic cardiac arrest: a data-driven approach. Crit Care 29, 485 (2025). https://doi.org/10.1186/s13054-025-05705-z. https://pubmed.ncbi.nlm.nih.gov/41233917/

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