Hemothorax and needle thoracostomies in prehospital traumatic cardiac arrest: An autopsy series of 172 cases.

Background: Trauma is an important cause of death worldwide, and the majority of deaths from trauma occur in the prehospital setting. The presence of hemothorax contributes to this mortality and is most frequently treated with needle thoracostomies, despite concerns about the effectiveness of this intervention. We present the results of an autopsy series of prehospital traumatic cardiac arrest, describing the frequency of hemothorax in this population and the estimated failure rate of needle thoracostomies. Methods: We used basic demographic data from Emergency Medical Services (EMS) records covering a mixed urban/suburban area in Ontario, Canada, to identify corresponding coroner's reports of cases of prehospital traumatic cardiac arrest. Demographics, injury details, presence and size of hemothorax and prehospital interventions were extracted. Results: Over a 5-year study period, we successfully identified 172 cases of prehospital traumatic cardiac arrest where resuscitation was provided on scene by paramedics. There was a predominantly blunt mechanism of injury (66%) and 96% of patients were in cardiac arrest on EMS arrival. The overall incidence of traumatic hemothorax was 70%. Needle thoracostomies were performed in 40 cases (23%) of traumatic cardiac arrest. Needle thoracostomy failed to decompress a massive hemothorax in 14 out of 33 cases (42%). Conclusions: We identified a high incidence of hemothorax in traumatic cardiac arrest and a high failure rate of needle thoracostomies for decompression of massive hemothorax. Further research is required to explore the feasibility and potential benefits of finger thoracostomy in prehospital traumatic cardiac arrest.