Abstract

Emergency resuscitative thoracotomy (ERT) is a time-sensitive surgical intervention used as a last option in trauma patients experiencing cardiac arrest or near-arrest. It aims to control hemorrhage, decompress pericardial tamponade, and preserve cerebral and coronary perfusion. This systematic review aimed to evaluate the effectiveness, indications, survival outcomes, and prognostic factors associated with ERT in trauma patients with blunt or penetrating injuries. The review followed Preferred Reporting Items for Systematic reviews and Meta-Analyses guidelines. Electronic databases (PubMed, Cochrane, Web of Science, and Scopus) were searched for studies published from 2012 to 2024. The studies with adult trauma patients (≥16 years) undergoing ERT or similar resuscitative procedures were included. Data were extracted using a pre-designed Excel sheet. Primary outcomes were mortality rates; secondary outcomes included neurological status and survival to discharge. Seven studies were included. Mortality rates varied widely, with better outcomes observed in penetrating injuries and when ERT was performed early. Endovascular approaches (e.g., resuscitative end ovascular balloon occlusion of the aorta) had good outcomes but similar mortality rates to thoracotomy. Thoracotomy performed in the operating room results in better survival than in the emergency department. Predictors of survival included the presence of signs of life, shorter prehospital CPR duration, and procedure timing. ERT is a lifesaver in selected trauma patients, mainly with penetrating injuries. Careful patient selection and timely intervention are critical to increase the survival rate and decrease futile procedures.

Key words: resuscitative thoracotomy, emergency department thoracotomy, penetrating trauma, hemorrhagic shock, review