title: Optimizing outcomes in emergency room thoracotomy: a 20-year experience in an urban Level I trauma center.
abstract: Emergency room thoracotomy (ERT) has remained a last resort tool of resuscitation in the management of patients with major trauma. The medical records of all patients undergoing ERT for penetrating chest trauma from January 1, 2000 through April 30, 2008 were retrospectively reviewed. The data from this study were added to data collected in two previous studies conducted at our institution for meta-analysis. A total of 102 ERTs were performed. There were 28 Class I patients (27.4%), 58 Class II (56.8%), six Class III (5.8%), and 11 Class IV (10.7%). The number of ERTs performed on Class I patients has decreased from 58.3 per cent in the 1995 group to 35.4 per cent in the 1999 group. There was an overall survival of 7.8 per cent in the current period of review. Overall survival in the 1995 group was 2.5 per cent, 1999 was 2.7 per cent, and 2008 was 7.8 per cent. The majority of the survival benefit occurs in patients who have electrical activity and a blood pressure when examined in the emergency department (Class III and IV). We intend to do future prospective research to further clarify the Class II patients when evaluating the type of rhythm shown on electrocardiogram tracing to move away from the generic pulseless electrical activity category.
authors.affiliation: Indiana University, Indianapolis, Indiana, USA.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Gomez
authors.forename: Alison
authors.initials: A
authors.lastname: Fecher
authors.forename: Theresa
authors.initials: T
authors.lastname: Joy
authors.forename: Ivanesa
authors.initials: I
authors.lastname: Pardo
authors.forename: Lewis
authors.initials: L
authors.lastname: Jacobson
authors.forename: Heather
authors.initials: H
authors.lastname: Kemp
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D018579:Patient Selection; D012189:Retrospective Studies; D015996:Survival Rate; D013898:Thoracic Injuries / Q000401:mortality / Q000601:surgery*; D013908:Thoracotomy; D014193:Trauma Centers; D016896:Treatment Outcome