Traumatic Emergency Thoracotomy for Resuscitation in Shock (TETRiS): a national service evaluation of resuscitative thoracotomy practice outside the operating theatre.

Abstract

Background: Resuscitative thoracotomy (RT) is performed in patients with traumatic cardiac arrest or peri-arrest to treat potentially reversible causes of circulatory collapse. Optimal patient selection and timing remain uncertain, and existing evidence is largely retrospective, often excluding prehospital deaths. This prospective service evaluation examined contemporary RT practice and outcomes across a national major trauma system, including prehospital and emergency department settings.

Methods: Prospective 12-month observational study across 20 UK Helicopter Emergency Medical Services and 26 Major Trauma Centre Emergency Departments, using the PHOTON, TERN, and NaTRIC research networks.

Results: A total of 116 patients underwent RT, of which 82 (70.7%) were performed prehospital. Median age was 30 years, 97 patients (83.6%) were male, and 81 (69.8%) sustained penetrating injury. Suspected cardiac tamponade was the most common indication for RT (72/116 [62.1%]), although operative findings demonstrated exsanguinating haemorrhage in 82 patients (70.7%). Overall, 50 patients (43.1%) achieved return of spontaneous circulation and eight (6.9%) survived to hospital discharge. Survival was strongly associated with pathophysiological cause, duration of arrest, and physiological state at the time of intervention, with substantially better outcomes observed in patients with cardiac tamponade than exsanguination. Patients undergoing emergency department RT demonstrated shorter arrest durations, more favourable physiology, and higher survival than those undergoing prehospital RT. There were no survivors beyond 10 minutes of traumatic cardiac arrest.

Conclusion: In this prospective national evaluation of RT practice, outcomes were strongly associated with the pathophysiological cause and duration of arrest, and the residual physiology present at the time of intervention. The most favourable outcomes were observed in patients with cardiac tamponade and those undergoing RT before irreversible physiological deterioration.