Behind The Knife: The Surgery Podcast Journal Review in Trauma Surgery: Getting to the Heart of the Problem - Prehospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest
Jan 22, 2026
Join Zane Perkins, a consultant trauma surgeon and pre-hospital expert, as he dives into the groundbreaking approach of prehospital resuscitative thoracotomy for traumatic cardiac arrest. Discover the intricate steps involved, from the clam-shell technique to effective patient selection using ultrasound. The discussion covers the debate of on-scene thoracotomy versus rapid transport, and insights into optimizing outcomes with advanced training protocols. Zane also highlights the importance of team welfare and the evolution of clinical guidelines in trauma care.
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Key Predictors Of Survival
- Prehospital resuscitative thoracotomy (RT) by London's Air Ambulance had a 5% survival to discharge in 601 cases over 1999–2019.
- Cause of arrest, arrest duration, and presenting rhythm were the strongest predictors of survival.
Dramatic Outcome Differences By Mechanism
- Survival varied dramatically by mechanism: tamponade 21%, exsanguination 2%, combined 0%.
- Short arrest-to-intervention times and favourable rhythms (PEA) markedly improved survival.
Act Within Minutes
- Prioritise speed: aim for RT within minutes of witnessed arrest; survival falls steeply after one minute.
- Use arrest duration thresholds (eg <10–15 minutes) when selecting candidates for RT.