Emergent pediatric thoracotomy following traumatic arrest.
OBJECTIVE
Emergent thoracotomy is a potentially life-saving procedure following traumatic cardiac arrest. The procedure has been studied extensively in adults, but its role in pediatric traumatic cardiac arrest remains unclear. We aimed to determine the prevalence of survival following emergent resuscitative thoracotomy in children.


METHODS
This was a retrospective cohort study that included consecutive patients<18 years old who underwent emergent thoracotomy following traumatic cardiac arrest over a 15-year period. Factors previously associated with survival following thoracotomy in adults were measured.


RESULTS
During the study period, 29 patients underwent emergent thoracotomy. Of these, 3 (10%, 95% confidence interval [CI]: 2-27%) survived to hospital discharge. All survivors sustained penetrating trauma to the heart and had signs of life on arrival of emergency medical services. Of the 13 patients who sustained blunt trauma, 0 (0%, 95% CI: 0-25%) survived, despite 69% (9/13) demonstrating signs of life on arrival of emergency medical services and 38% (5/13) having temporary return of spontaneous circulation.


CONCLUSIONS
Emergent thoracotomy is a potentially life-saving procedure for children following traumatic cardiac arrest. It appears most successful in children suffering penetrating trauma to the heart with signs of life on arrival of emergency medical services. Larger studies are needed to determine the factors associated with this survival benefit for emergent thoracotomy in children.
Department of Emergency Medicine, Denver Health Medical Center, Denver, CO, USA. Joshua.Easter@dhha.org
Joshua S
JS
Easter
Deborah T
DT
Vinton
Jason S
JS
Haukoos
D000293:Adolescent; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004638:Emergency Treatment; D005260:Female; D006323:Heart Arrest / Q000209:etiology* / Q000601:surgery*; D006801:Humans; D008297:Male; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D013898:Thoracic Injuries / Q000150:complications*; D013908:Thoracotomy