Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment. The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant. Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs. Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.

中文翻译：

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由直升机紧急医疗服务在城乡混合地区实施的 6 年复苏性开胸病例系列，比较钝伤与穿透伤

复苏性开胸术 (RT) 是一种干预措施，可以在院前环境中进行，以减轻创伤性心脏骤停患者的心脏压塞和/或获得对疑似膈下出血的血管控制。本回顾性案例研究的目的是比较在混合城市和农村环境中进行的穿透伤和钝伤超过 6 年的 RT 中自发循环 (ROSC) 的恢复率。在 2015 年 6 月 1 日至 2021 年 5 月 31 日期间，对单一直升机紧急医疗服务的电子记录进行了审查，以用于 RT。为相关案例提取了包括人口统计在内的匿名数据。用独立的t检验和Χ2检验分析数据。p 值 < 0.05 被认为具有统计学意义。在 6 年内进行了 44 次 RT（钝挫伤 26 次）。实现了 11 个 ROSC（9 个钝性，2 个穿透性），但没有患者存活出院。与穿透性创伤的 RT 相比，12 个钝性创伤的 RT 在院前团队到达时有心输出量 (p = 0.01)。两名患者在直升机上进行了 RT（一名 ROSC），两名在直升机停机坪上进行了 RT（均达到 ROSC），这可能是由于在更农村的环境中看到的转移时间更长。四个钝性创伤放疗（15%）被发现有心脏压塞，而穿透性创伤放疗有七个（39%）。院前 RT 仍然是一种存活率较低的程序，但可能有助于 ROSC 使患者能够到达医院和进行手术，特别是当到医院的距离较远时。