title: Basic data underlying clinical decision-making and outcomes in emergency department thoracotomy: tabular review.
abstract: BACKGROUND
  Emergency department thoracotomy (EDT) is a formidable and dramatic last attempt by the trauma surgeon to save the life of a patient in extremis. The aim of this report is to provide a benchmark for comparison with past results by reviewing all available published data since the American College of Surgeons Committee on Trauma review article in 2001, which reviewed literature from 1966 to 1999 regarding indications for and outcomes of EDT.
  
  
  METHODS
  A comprehensive literature search in MEDLINE Library databases was performed for EDT. Data were extracted by three independent reviewers.
  
  
  RESULTS
  We identified 37 papers with a total of 3466 patients. A total of 85.2% (1720 of the 2018) had penetrating trauma, 58.3% (372 of the 638) had cardiac injuries, 43.0% (251 of the 584) had thoracic injuries and 26.2% (143 of the 546) had abdominal injuries. The overall rate survival in this review was 8% (267 of the 3466, range 0-33.3%). Of 25 papers reporting cases of EDT for penetrating traumas, their survival rate was 9.8% (169 of the 1719, range 0-45.5); similarly, of 14 papers assessing EDT for blunt injuries, the survival rate was 5.2% (24 of the 460, range 0-12.2). Of 15 papers reporting neurological outcomes 84.6% (143 of the 169, range 50-100%) of patients returned to baseline. The survival outcome of EDT in US experience versus non-US experiences was 6.3% (164 of the 2612, range 0-14.9) versus 11.9% (89 of the 745, range 0-33.3) respectively.
  
  
  CONCLUSIONS
  The authors intend this review to serve as a practical and prompt literature search tool for all surgeons who encounter resuscitative thoracotomy in their practice.
authors.affiliation: San Joaquin General Hospital, University of California, Davis, French Camp, California, USA.
authors.forename: Anand
authors.initials: A
authors.lastname: Dayama
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Dordaneh
authors.initials: D
authors.lastname: Sugano
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Daniel
authors.initials: D
authors.lastname: Spielman
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Melvin E
authors.initials: ME
authors.lastname: Stone
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: Jody
authors.initials: J
authors.lastname: Kaban
authors.affiliation: San Joaquin General Hospital, University of California, Davis, French Camp, California, USA.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Mahmoud
authors.affiliation: Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
authors.forename: John
authors.initials: J
authors.lastname: McNelis
mesh_terms: D000007:Abdominal Injuries / Q000601:surgery; D000328:Adult; D000066491:Clinical Decision-Making / Q000379:methods*; D004635:Emergency Medicine / Q000379:methods*; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D063868:Patient Outcome Assessment; D013908:Thoracotomy / Q000379:methods*; D014949:Wounds, Nonpenetrating / Q000601:surgery; D014950:Wounds, Penetrating / Q000601:surgery
keywords: emergency department thoracotomy; resuscitative thoracotomy; trauma