Clinical paperRole of resuscitative emergency field thoracotomy in the Japanese helicopter emergency medical service system☆
Introduction
Saving the life of a patient who suffers cardiac arrest after experiencing a severe blunt trauma is extremely difficult, and this is true throughout the world. In Japan, this difficulty is considered to be partially attributable to the conventional emergency medical service system (EMS). If another EMS scheme for dispatching physicians to the scenes of accidents were to be established, new data and thorough discussions would be required with regard to interventions for pre-hospital trauma management.
In the United States, a resuscitative emergency department thoracotomy (EDT) for cardiac arrest patients who have sustained blunt trauma is only indicated in limited cases because the overall survival of these patients is extremely poor.1, 2 Also, while the helicopter emergency medical service (HEMS) is quite advanced in the US, on-board physicians are rare. Instead, on-scene primary care is provided by paramedics and rapid transport to an emergency care hospital is the main mission. This system differs from the HEMS concept that we are trying to realize in Japan, which resembles the European HEMS system,3, 4, 5, 6 and this difference should be taken into account when assessing emergency care for cardiac arrest patients who have sustained blunt trauma.
The Japanese government is currently promoting a “doctor-helicopter” system.7 In this system, a helicopter that has been specially configured for EMS care and an on-board physician and nurse are rushed to the accident scene. Since 2003, we have been using this HMES system to take a proactive approach to performing emergency thoracotomies at the accident scene when such a procedure is required for the treatment of patients experiencing cardiac arrest after they have sustained blunt trauma; we refer to this procedure as an emergency field thoracotomy (EFT). The aim of the present study was to investigate whether EFT contributes to saving the lives of blunt trauma patients with impending or recent cardiac arrest.
Section snippets
Materials and methods
The HEMS system in Japan is alerted by a direct call from the dispatch center or EMS provider at the accident scene. The Shock and Trauma Center at Chiba Hokusoh Hospital of Nippon Medical School, which is the base hospital of the HEMS system for Chiba prefecture and corresponds to a Level 1 trauma center in the US, has over 700 HEMS missions per year. Our flight crews include one emergency physician and one flight nurse per helicopter. The helicopter is airborne within 3.5 min after the call
Results
The overall survival rate of the patients treated using a resuscitative emergency thoracotomy after sustaining a blunt trauma was 3.2% (3/95), whereas the survival of patients who received an emergency thoracotomy after cardiac arrest was 1.1% (1/90). Of the 81 cases included in the present analysis, 52 cases were in cardiac arrest before the EMT arrived at the accident scene, whereas 29 experienced cardiac arrest after the arrival of the EMT; 5 of these 29 cases experienced cardiac arrest
Discussion
The role and efficacy of emergency thoracotomy as a life-saving procedure is somewhat unclear because of the numerous different situations and patient characteristics that can affect the place or timing of this procedure.8 In a review of 4620 cases from institutions reporting the use of emergency thoracotomy for the treatment of patients with either blunt or penetrating trauma, the overall survival rates ranged from 1.8% to 27.5%.9 In general, an emergency thoracotomy is regarded as an
Conclusions
In conclusion, the time from EMT arrival to the performance of an emergency thoracotomy was significantly shorter in the groups in which doctors were dispatched to the accident scene. The numbers of patients who had meaningful heartbeat restoration and who were admitted to the ICU after the removal of aortic clamping were significantly larger in the group who experienced cardiac arrest after EMT arrival and who underwent an on-scene emergency thoracotomy, compared with the other groups. These
Conflict of interest statement
None to declare.
References (21)
- et al.
Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation?
J Am Coll Surg
(2004) - et al.
Helicopter mountain rescue of patients with head injury and/or multiple injuries in southern Switzerland 1980–1990
Injury
(1993) - et al.
Emergency thoracotomy in thoracic trauma—a review
Injury
(2006) - et al.
Survival after emergency department thoracotomy: review of published data from the past 25 years
J Am Coll Surg
(2000) - et al.
Penetrating cardiac injuries: a prospective study of variables predicting outcomes
J Am Coll Surg
(1998) - et al.
A successful emergency thoracotomy performed in the field
Resuscitation
(2007) - et al.
Resuscitative emergency thoracotomy in a Scandinavian trauma hospital—is it justified?
Injury
(2007) - et al.
Pre-hospital thoracotomy: a radical resuscitation intervention come of age?
Resuscitation
(2007) - et al.
Emergency department thoracotomy
- et al.
Effects of London helicopter EMS on survival after trauma
BMJ
(1995)
Cited by (44)
Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis
2022, Journal of Surgical ResearchCitation Excerpt :The quality of evidence was rated as very low (Table 1). Of these, 43 were included in the analysis of RT setting3,8,11,14–36,38–46,51–53,55–59, and 40 were included in the analysis of RT for blunt versus penetrating trauma.8,11,14–18,20–29,31–36,38–46,51–53,55–59 Five studies evaluated PH-RT (eTable 1a).11,15,37,44,58
Dispatch of Helicopter Emergency Medical Services Via Advanced Automatic Collision Notification
2016, Journal of Emergency Medicine
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A Spanish translated version of the summary of this article appears as Appendix in the online version at doi:10.1016/j.resuscitation.2009.08.010.