title: Resuscitative thoracotomy following wartime injury.
abstract: BACKGROUND
  The evidence for resuscitative thoracotomy (RT) in trauma patients following wartime injury is limited; its indications and timings are less defined in battle injury. The aim of this study was to analyze survival as well as the causes and times of death in patients undergoing RT within the context of modern battlefield resuscitation.
  
  
  METHODS
  A retrospective cohort study was performed on consecutive admissions to a Field Hospital in Southern Afghanistan. All patients undergoing RT were identified using the UK Joint Theatre Trauma Registry. The primary outcome was 30-day mortality, and secondary outcomes included location of cardiac arrest, time from arrest to thoracotomy, and proportion achieving a return of spontaneous circulation.
  
  
  RESULTS
  Between April 2006 to March 2011, 65 patients underwent RT with 14 survivors (21.5%). Ten patients (15.4%) had an arrest in the field with no survivors, 29 (44.6%) had an arrest en route with 3 survivors, and 26 (40.0%) had an arrest in the emergency department with 11 survivors. There was no difference in Injury Severity Scores (ISSs) between survivors and fatalities (27.3 [7.6] vs. 36.0 [22.1], p = 0.636). Survivors had a significantly shorter time to thoracotomy than did fatalities (6.15 [5.8] minutes vs. 17.7 [12.63] minutes, p < 0.001).
  
  
  CONCLUSIONS
  RT following combat injury will yield survivors. Best outcomes are in patients who have an arrest in the emergency department or on admission to the hospital.
  
  
  METHODS
  Epidemiologic/prognostic study, level III.
authors: US Army Institute of Surgical Research, Fort Sam Houston, Texas, USA. jjmorrison@outlook.com
authors: Jonathan J
authors: JJ
authors: Morrison
authors: Henrietta
authors: H
authors: Poon
authors: Todd E
authors: TE
authors: Rasmussen
authors: Mansoor A
authors: MA
authors: Khan
authors: Mark J
authors: MJ
authors: Midwinter
authors: Lorne H
authors: LH
authors: Blackbourne
authors: Jeffery P
authors: JP
authors: Garner
mesh_terms: D000328:Adult; D055826:Afghan Campaign 2001-; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015601:Injury Severity Score; D008297:Male; D011379:Prognosis; D012151:Resuscitation / Q000379:methods*; D012189:Retrospective Studies; D015996:Survival Rate; D013908:Thoracotomy / Q000379:methods* / Q000706:statistics & numerical data; D016896:Treatment Outcome; D006113:United Kingdom / Q000453:epidemiology; D014947:Wounds and Injuries / Q000175:diagnosis / Q000401:mortality / Q000628:therapy*; D055815:Young Adult