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. 2025 Jan 16:22:100870.
doi: 10.1016/j.resplu.2025.100870. eCollection 2025 Mar.

Adherence to prehospital thoracostomy practice guidelines for traumatic cardiac arrest: A retrospective study

Nicolas Beysard  1   2 , Tara Agudo  2 , Peter Serfozo  1 , Tobias Zingg  2   3 , Perrine Truong  1 , Roland Albrecht  4 , Vincent Darioli  1 , Mathieu Pasquier  1   2
Affiliations

Adherence to prehospital thoracostomy practice guidelines for traumatic cardiac arrest: A retrospective study

Nicolas Beysard et al. Resusc Plus. .

Abstract

Objectives: The management of traumatic cardiac arrest (TCA) focuses on the immediate treatment of reversible causes, including bilateral thoracostomy. In our prehospital emergency service, bilateral thoracostomy has been recommended since 2012 for the management of TCA. We sought to analyse the prehospital management and clinical course of patients with TCA, focusing on changes over time in the use of thoracostomy.

Methods: In this single-centre retrospective observational study, we included patients with TCA managed by physicians of the prehospital service of Lausanne University Hospital from 2012 to 2024. The primary outcome was the annual rate of bilateral thoracostomy. Secondary outcomes included the rate of additional on-site measures, such as pelvic binder placement and airway management, and follow-up at 48 h.

Results: Among 3206 cardiac arrests during the study period, 473 (15%) were TCAs. Among the 247 patients with resuscitation attempts, thoracostomy was judged as indicated in 223 (90%) and performed in 148 (66%). Twenty-seven (18%) patients who had a thoracostomy were alive on arrival at hospital, with 9 (6.1%) still alive at 48 h. The mean annual proportion of patients in whom a thoracostomy was performed was 68% (range 0-100%) and increased significantly over the years (p < 0.001).

Conclusions: The annual rate of thoracostomy in TCA patients increased significantly in the period 2012 to 2024. Larger studies are required to determine the impact of thoracostomy on survival.

Keywords: Adherence; Guidelines; Prehospital; Thoracostomy; Traumatic cardiac arrest.

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Conflict of interest statement

The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.

Figures

Fig. 1
Fig. 1
Flow chart of study patients. Patients with traumatic cardiac arrest (TCA) managed by prehospital emergency physicians of Lausanne University Hospital, Switzerland, 2012–2024.
Fig. 2
Fig. 2
Annual proportion of patients in whom resuscitation was attempted and with an indication for thoracostomy, and in whom a thoracostomy and/or a pelvic binder was applied (n = 223), with traumatic cardiac arrest managed by the prehospital emergency physicians of the Lausanne University Hospital, Switzerland, 2012–2024.
See this image and copyright information in PMC

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