title: Are there still selected applications for resuscitative thoracotomy in the emergency department after blunt trauma?
abstract: Resuscitative thoracotomy has an integral role for open cardiac massage and can be preformed after penetrating trauma with cardiovascular collapse. Its role in blunt trauma is questionable. We performed a retrospective chart review of patients who underwent an emergency department (ED) resuscitative thoracotomy. The goal was to define the role of resuscitative thoracotomy in blunt trauma at our institution. Forty-two patients underwent a resuscitative thoracotomy, 26 penetrating trauma (61.9%) and 16 blunt trauma (38.1%). Of these (n=16), there were 13 thoracic injuries (81.2%), eight cardiac injuries (50.0%), seven isolated abdominal injuries (43.7%) and 13 multiple (two or more locations) injuries (81.2%). Therapeutic interventions included pericardiotomy in 14 (87.5%), cardiac repair in three (18.7%), and pulmonary laceration repair in two (12.5%). All study patients had signs of life in the field; 13 maintained signs of life in transit (81.3%) and 12 upon admission to ED (75%). Average time from field to ED was 10.72 +/- 5.74 minutes. There were two survivors after blunt trauma (12.5%) and one after penetrating trauma (3.8%). Signs of life in the field and a cardiac repair were independent predictors of survival after blunt trauma (p=0.001 and p=0.004 respectively). We conclude that in select trauma patients after blunt injury with cardiovascular collapse, resuscitative thoracotomy still has a vital role.
authors.affiliation: Christiana Hospital in Newark, Delaware, USA.
authors.forename: Michael
authors.initials: M
authors.lastname: Kalina
authors.forename: Erin
authors.initials: E
authors.lastname: Teeple
authors.forename: Gerard
authors.initials: G
authors.lastname: Fulda
mesh_terms: D000328:Adult; D016887:Cardiopulmonary Resuscitation / Q000379:methods*; D003691:Delaware / Q000453:epidemiology; D004636:Emergency Service, Hospital / Q000458:organization & administration*; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D015996:Survival Rate; D013898:Thoracic Injuries / Q000601:surgery*; D013908:Thoracotomy / Q000379:methods*; D016896:Treatment Outcome; D014949:Wounds, Nonpenetrating / Q000401:mortality / Q000601:surgery*; D014950:Wounds, Penetrating / Q000401:mortality / Q000601:surgery