Surviving against the odds: outcomes of emergency resuscitative thoracotomies at an Australian level 1 trauma centre


  • Raymond R. Hayler Department of Surgery, St George Hospital, Kogarah, NSW, Australia
  • Arushi Singh Department of Surgery, St George Hospital, Kogarah, NSW, Australia
  • Selwyn T. Selvendran Department of Surgery, St George Hospital, Kogarah, NSW, Australia
  • Mary E. Langcake Department of Surgery, St George Hospital, Kogarah, NSW, Australia



Trauma, Resuscitative thoracotomy, Emergency thoracotomy, Survival, Major trauma, Thoracic trauma


Background: Emergency resuscitative thoracotomy (ERT) is performed in thoracic trauma patients who present in extremis. Newer studies outside North America report higher survival rates, however literature from Australia is limited. This study reviews 12 years of ERT outcomes from an Australian level 1 trauma centre and whether trauma triage mechanisms may impact survival rates

Methods: A retrospective observational study using data from the trauma registry at St. George hospital Sydney for all who underwent an ERT between 2009 and 2021, supplemented with information from medical records. Parameters examined included demographics, injury profile, ERT details and outcomes. Data was then analysed by descriptive statistics

Results: The 29 ERTs were performed of which 25 were male (85%) and 4 were female (14%). Mean age was 40 and mean injury severity score (ISS) was 32. Overall, 13 patients survived after ERT (45%), with 10 patients surviving admission post ERT for penetrating injuries (53%), compared to 3 surviving admissions for blunt injuries (27%). The 82% of ERTs were performed in the operating theatre (OT), with survival rates the highest when ERT was performed in OT by the cardiothoracic surgical team

Conclusions: In this study, ERT conferred good outcome with survival in almost half of patients. More studies are required to establish whether triage mechanisms which facilitate early transfer to OT confer higher survival in ERT patients.


Seamon MJ, Haut ER, Van Arendonk K. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159-73.

Dayama A, Sugano D, Spielman D. Basic data underlying clinical decision-making and outcomes in emergency department thoracotomy: tabular review. ANZ J Surg. 2016;86(1-2):21-6.

Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons. Committee on Trauma. Practice management guidelines for emergency department thoracotomy. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons-Committee on Trauma. J Am Coll Surg. 2001;193(3):303-9.

Thorsen K, Vetrhus M, Narvestad JK. Performance and outcome evaluation of emergency resuscitative thoracotomy in a Norwegian trauma centre: a population-based consecutive series with survival benefits. Injury. 2020;51(9):1956-60.

Joseph B, Khan M, Jehan F, Latifi R, Rhee P. Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program. Trauma Surg Acute Care Open. 2018;3(1).

Grabs AJ, May AN, Fulde GW, McDonell KA. Code crimson: a life-saving measure to treat exsanguinating emergencies in trauma. ANZ J Surg. 2008;78(7):523-5.

Stevenson M, Segui-Gomez M, Lescohier I, Di Scala C, McDonald-Smith G. An overview of the injury severity score and the new injury severity score. Inj Prev. 2001;7(1):10-13.

Tovmassian D, Hameed AM, Ly J. Process measure aimed at reducing time to haemorrhage control: outcomes associated with Code Crimson activation in exsanguinating truncal trauma. ANZ J Surg. 2020;90(4):481-5.

Partyka C, Miller M, Johnson T. Prehospital activation of a coordinated multidisciplinary hospital response in preparation for patients with severe hemorrhage. A state-wide data linkage study of the New South Wales "Code Crimson" pathway. J Trauma Acute Care Surg. 2022;10:1097.






Original Research Articles