Critical analysis of thoracotomies performed in the emergency room in 10 years

Guimarães, Marcelo Beck; Winckler, Diego Carrão; Rudnick, Nádia Gabriele; Breigeiron, Ricardo

doi:10.1590/0100-69912014004007

Cited by 4 publications

(4 citation statements)

References 15 publications

(16 reference statements)

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“…In accordance with the literature 8,16 , most patients undergoing RT in our study were male (89.1%) and belonged to the young age group, with a mean age of 34.1 years. Similar to our results, the sample from the Brazilian study by Guimarães et al showed that 89.5% of patients undergoing RT were male and the mean age was 29.2 years 15 . As for the trauma mechanism, our study showed the predominance of penetrating trauma.…”

Section: Discussionsupporting

confidence: 91%

Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis

Haida

Yamashita

Franco

et al. 2022

Rev. Col. Bras. Cir.

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Objective: the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. Methods: retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. Results: a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. Conclusion: the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.

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Section: Discussionsupporting

confidence: 91%

Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis

Haida

Yamashita

Franco

et al. 2022

Rev. Col. Bras. Cir.

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“…Victims of blunt trauma who have the poorest prognosis for survival have been demonstrated by a variety of authors, with survival to discharge ranging from 0.0 to 2.9% 13, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38, 39, 40. No patients with blunt trauma survived to discharge in the current study.…”

Section: Discussionmentioning

confidence: 49%

“…We believe that the potential survivor constitutes the patient population for whom the opportunity for survivability should be provided. For the above studies in which survival of the resuscitative thoracotomy can be determined, 0.0–18.7% of blunt injured patients23, 27, 31, 36, 38, 39, 40 and 8.7%–78.6% of all patients13, 16, 19, 20, 22, 23, 24, 25, 27, 28, 31, 32, 33, 35, 36, 37, 41, 42, 43 regained a sustained heartbeat. In the current study 11 of 43 blunt injured patients (25.6%) and 27 of all 68 patients (39.7%) regained a sustained heartbeat.…”

Section: Discussionmentioning

confidence: 99%

Thoracotomy in the emergency department for resuscitation of the mortally injured

Angus

2017

Chinese Journal of Traumatology

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PurposeEmergency department resuscitative thoracotomy is an intervention of last resort for the acutely dying victim of trauma. In light of improvements in pre-hospital emergency systems, improved operative strategies for survival such as damage control and improvements in critical care medicine, the most extreme of resuscitation efforts should be re-evaluated for the potential survivor, with success properly defined as the return of vital signs which allow transport of the patient to the operating room.MethodsA retrospective review of all patients at a suburban level I trauma center who underwent emergency department resuscitative thoracotomy as an adjunct to the resuscitation efforts normally delivered in the trauma receiving area over a 22 year period was performed. Survival of emergency department resuscitative thoracotomy was defined as restoration of vital signs and transport out of the trauma resuscitation area to the operating room.ResultsSixty-eight patients were identified, of whom 27 survived the emergency department resuscitative thoracotomy and were transported to the operating room. Review of pre-hospital and initial hospital data between these potential long term survivors and those who died in the emergency department failed to demonstrate trends which were predictive of survival of emergency department resuscitative thoracotomy. The only subgroup which failed to respond to emergency department resuscitative thoracotomy was patients without signs of life at the scene who arrived to the treatment facility without signs of life.ConclusionThe patient population of the “potential survivor” has been expanded due to advances in critical care practices, technology, and surgical technique and every opportunity for survival should be provided at the outset. Emergency department resuscitative thoracotomy is warranted for any patient with thoracic or subdiaphragmatic trauma who presents in extremis with a history of signs of life at the scene or organized cardiac activity upon arrival. Patients who have no evidence of signs of life at the scene and have no organized cardiac activity upon arrival should be pronounced.

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“…2,3 Previous studies have identified overall poor outcomes following RT, particularly in the context of blunt injuries when compared to penetrating trauma. [4][5][6][7][8] Additionally, several factors have been linked to lower likelihoods of survival, including the performance of RT more than 30 min after hospital arrival, RT in the context of traumatic cardiac arrest (TCA), the patient's clinical status on emergency department (ED) arrival, RT procedure duration, heart rate (HR) at the end of the procedure, absence of signs of life (SOL) on-scene or in the ED, and cardiopulmonary resuscitation (CPR) duration. [9][10][11][12][13] However, to date, data have primarily focused on in-hospital and injury-specific variables and literature that synthesizes what we know about outcome predictors in the trauma population following RT is lacking.…”

Section: Introductionmentioning

confidence: 99%

Predictors of survival in trauma patients requiring resuscitative thoracotomy: A scoping review

Radulovic

Nolan

2023

Trauma

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Introduction Resuscitative thoracotomy (RT) is an emergent procedure to gain access to the thoracic cavity to control hemorrhage and other life-threatening injuries. Data predicting survival is variable. This review aims to highlight key predictors of survival and mortality following RT. Methods The EMBASE database was searched using the following terms: [exp. Thoracotomy] AND [Trauma.mp] AND [exp. Survival OR exp. Mortality]. The search was limited to full-text articles in the English language and publications released up to February 27, 2022. Reference lists of included articles were reviewed to identify other studies meeting inclusion criteria. Results Thirty-seven studies were included. Seventy-six outcome predictors were identified. Prehospital outcome predictors included prehospital vital signs, police transport, cardiopulmonary resuscitation, application of a cervical spine collar, and the number of total prehospital procedures performed. In-hospital variables associated with survival included traumatic cardiac arrest (TCA) in the emergency department (ED), initial ED vital signs and cardiac rhythm, Shock Index Pediatric Age-Adjusted score, location of RT, duration of RT, Focused Assessment with Sonography in Trauma findings, amount of blood products, and amount of administered fluids. Conclusions Our study highlights the disparity of data regarding prehospital outcome predictors for trauma patients requiring RT. Most studies focus on injury-specific and in-hospital variables and do not explicitly look at the TCA population. Further work is needed to better define specific variables implicated in enhanced survival across different care settings and to inform management guidelines within these clinical areas.

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Critical analysis of thoracotomies performed in the emergency room in 10 years

Abstract: The results obtained in the Emergency Hospital of Porto Alegre POA-HPS are similar to those reported in the world literature.

Cited by 4 publications

References 15 publications

Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis

Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis

Thoracotomy in the emergency department for resuscitation of the mortally injured

Predictors of survival in trauma patients requiring resuscitative thoracotomy: A scoping review

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