Utility of Prehospital Emergency Resuscitative Thoracotomy in Trauma Patients: An Analysis Using the Japanese Society for Aeromedical Services Registry.
Air Medical Journal · 2026-01-01 · Registry study
Abstract
OBJECTIVE: Emergency resuscitative thoracotomy (ERT) is a crucial intervention employed in prehospital settings to address life-threatening conditions, such as cardiac tamponade, hemorrhage, and air embolism. Despite its critical nature, the efficacy of prehospital ERT in enhancing survival rates compared with in-hospital procedures remains controversial. METHODS: This retrospective analysis was conducted using data from the Japanese Society for Aeromedical Services Registry between January 2020 and December 2022. After excluding nontraumatic cases, non-ERT cases, and records with missing data, 143 prehospital ERT cases were identified. The cohort was categorized into survivors (n = 3) and nonsurvivors (n = 140) based on patient outcomes. Comparative analyses were conducted on variables such as age, injury severity, time intervals, and transportation modalities using the Wilcoxon rank-sum test and Pearson's chi-square test, with the statistical significance set at P < .05. RESULTS: The overall survival rate after prehospital ERT was 2.1% (3 of 143). Only a few variables, such as hospital length of stay, showed statistically significant differences between the groups; most patient characteristics and prehospital time intervals did not. The patients who experienced cardiac arrest at the time of contact with the emergency medical service (EMS) contact had a survival rate of 0%, whereas those who arrived at the hospital with vital signs had the highest survival rate (11.1%). The presence of vital signs upon hospital arrival and the rapid initiation of intervention were identified as key factors influencing survival. CONCLUSION: These findings suggest that prehospital ERT provides limited survival benefits, with a 0% survival rate in cases of cardiac arrest at EMS contact. Therefore, further research is essential to refine the patient selection criteria and optimize ERT deployment to improve prehospital patient outcomes.
Abstract © the authors or publisher, via PubMed. Reuse and removal
Tags
Helicopter & air ambulance · Mortality & survival · Resuscitative thoracotomy
Related articles
- Traumatic Emergency Thoracotomy for Resuscitation in Shock (TETRiS): a national service evaluation of resuscitative thoracotomy practice outside the operating theatre. (Resuscitation, 2026)
- A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma. (Scand J Trauma Resusc Emerg Med, 2022)
- Prehospital continuous vital signs predict need for resuscitative endovascular balloon occlusion of the aorta and resuscitative thoracotomy prehospital continuous vital signs predict resuscitative endovascular balloon occlusion of the aorta. (J Trauma Acute Care Surg, 2021)
- [Successful prehospital emergency thoracotomy after blunt thoracic trauma : Case report and lessons learned]. (Unfallchirurg, 2018)
- Role of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system. (Resuscitation, 2009)
- Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. (J Trauma, 2001)