The place of resuscitative thoracotomy in prehospital care A talk by Zane Perkins at TBS23

1. The place of
RESUSCITATIVE THORACOTOMY
in Pre-Hospital Care
Zane Perkins
Consultant Trauma Surgeon, Royal London Hospital
Consultant in Pre-Hospital Care, London’s Air Ambulance
Honorary Senior Lecturer, Centre for Trauma Sciences
@ZBPerkins

2. Mike Christian Rob Greenhalgh
Shad Aziz Andy Whitehouse
Steve Read Liz Foster
Christine Henry Max Marsden
Robbie Lendrum Frank Chege
David Lockey Gareth Davies

4. Lott C et al. Resuscitation (2021)

5. Futile?
Survivable window?
Pre-hospital or In-hospital?
Penetrating versus Blunt?

6. STUDY PERIOD:
London’s Air Ambulance
INCLUSION:
OUTCOMES:
SETTING:
1999 to 2019 (21 years)
Pre-Hospital Thoracotomy
1º Survival to hospital discharge
2º Survived Event
Favorable Neurological Survival

7. Step 1 Clamshell thoracotomy
Step 2 Open Pericardium ‘⏊’
Step 3 Repair Wound(s)
Step 0 Bilateral thoracostomies
Step 4 Restart the Heart

8. 45 647
601 (1.3%)
Injured Patients
Resuscitative Thoracotomy
Cardiac Tamponade
Exsanguination
Both
105
418
72

9. Futile?

10. CARDIAC TAMPONADE

15. EXSANGUINATION

17. CARDIAC TAMPONADE EXSANGUINATION

18. CARDIAC TAMPONADE EXSANGUINATION

30. Survivable Window?

32. Time

33. Time

35. Time

36. TAMPONADE
EXSANGUINATION
Organised
Cardiac Activity
No Organised
Cardiac Activity
< 15 min

37. Pre-Hospital or In-Hospital?

40. Penetrating versus Blunt?

42. TCA occurs soon after injury
Pre-Hospital Resuscitative Thoracotomy:
- is an effective (time-critical) intervention for Tamponade TCA
- has limited effectiveness for Exsanguination TCA
ECG can inform decision-making and prognostication