This prospective UK service evaluation followed 116 patients undergoing resuscitative thoracotomy, including 82 treated prehospital, across a national trauma system. Median age was 30 years, and 69.8% had penetrating injuries. Return of spontaneous circulation occurred in 50 patients (43.1%), while eight (6.9%) survived to hospital discharge. Survival was associated with arrest duration, underlying cause, and physiology at intervention, with better outcomes for tamponade than exsanguination. Emergency department patients had shorter arrest durations, more favourable physiology, and higher survival than prehospital patients; no patients survived beyond 10 minutes of traumatic cardiac arrest.
Survival after resuscitative thoracotomy was uncommon and varied with cause, arrest duration, and residual physiology. These observational findings do not establish a causal advantage for emergency department intervention or a definitive arrest-duration cutoff.
Study limitation: The observational design and differing arrest durations and physiology between settings limit causal comparisons of prehospital and emergency department outcomes.
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