Abstract / Summary
Resuscitative thoracotomy (RT) is an extreme, open‑chest intervention for patients with acute traumatic cardiac arrest (TCA). While infrequently applied due to its invasiveness and historically poor overall survival, RT may be life‑saving in selected combat casualties. This study evaluated the utility, indications, and outcomes of emergent RT in deployed Ukrainian Role 2/3 field hospitals during the Russia-Ukraine war. Retrospective analysis was performed for 406 male combat patients with TCA treated at Role 2/3 military field hospitals in Eastern Ukraine. Fifty‑nine (14.5%) underwent RT per ATLS guidelines, and 347 (85.5%) received closed‑chest CPR. Injury patterns, transport times, survival outcomes, and short‑term follow‑up were assessed. Fisher’s exact test was used to determine significance ( p < 0.05). Injuries included penetrating cardiac wounds (55.9%), chest/lung injuries (15.3%), abdominal organ damage (20.3%), and extremity vascular/bone injuries (8.5%). All patients presented with signs of life. In the CPR group, 96/347 (27.7%, [95% CI 0.2322, 0.3260]) survived, which was lower than the RT group 21/59 (36% [95% CI 0.5162, 0.7543]), but without statistical significance. However, 3‑day survival favored RT 10/21 (48%, [95% CI 0.2834, 0.6763]), as compared to the CPR group 8/96 (8.3%, [95% CI 0.0407, 0.1580]), p < 0.0001. RT effectiveness correlated strongly with time to care: survival was 85.3% for admission within 10 min, 11.6% within 30 min, and 3.1% within 60 min. Most deaths resulted from progressive shock. In high‑intensity combat settings, resuscitative thoracotomy should be considered in selected cases as a potentially life‑saving intervention, particularly for penetrating cardiac injuries and patients with objective signs of life when transport to definitive care is extremely rapid. Optimal application requires trained teams, rapid evacuation pathways, and integration of military-civil trauma systems. Not applicable.