An evidence-based approach to patient selection for emergency department thoracotomy

Seamon, Mark J.; Haut, Elliott R.; Arendonk, Kyle J. Van; Barbosa, Ronald R.; Chiu, William C.; Dente, Christopher J.; Fox, Nicole; Jawa, Randeep S.; Khwaja, Kosar; Lee, J. Kayle; Magnotti, Louis J.; Mayglothling, Julie; McDonald, Amy A.; Rowell, Susan; To, Kathleen; Falck‐Ytter, Yngve; Rhee, Peter

doi:10.1097/ta.0000000000000648

Cited by 268 publications

(169 citation statements)

References 74 publications

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“…In this study, we could not conclude that OCCPR was superior to CCCPR in patients without cardiac arrest on ED arrival, despite this subset of patients being previously described as ideal candidates for OCCPR [21, 22]. This result was consistent with the findings of Suzuki et al [14].…”

Section: Discussionsupporting

confidence: 78%

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

et al. 2017

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BackgroundAlthough open-chest cardiopulmonary resuscitation (OCCPR) is often considered as the last salvage maneuver in critically injured patients, evidence on the effectiveness of OCCPR has been based only on the descriptive studies of limited numbers of cases or expert opinions. This study aimed to compare the effectiveness of OCCPR with that of closed-chest cardiopulmonary resuscitation (CCCPR) in an emergency department (ED).MethodsA nationwide registry-based, retrospective cohort study was conducted. Patients with blunt trauma, undergoing cardiopulmonary resuscitation (CPR) in an ED between 2004 and 2015 were identified and divided into OCCPR and CCCPR groups. Their outcomes (survival to hospital discharge and survival over 24 hours following ED arrival) were compared with propensity score matching analysis and instrumental variable analysis.ResultsA total of 6510 patients (OCCPR, 2192; CCCPR, 4318) were analyzed. The in-hospital and 24-hour survival rates in OCCPR patients were 1.8% (40/2192) and 5.6% (123/2192), and those in CCCPR patients were 3.6% (156/4318) and 9.6% (416/4318), respectively. In the propensity score-matched subjects, OCCPR patients (n = 1804) had significantly lower odds of survival to hospital discharge (odds ratio (95% CI)) = 0.41 (0.25–0.68)) and of survival over 24 hours following ED arrival (OR (95% CI) = 0.59 (0.45–0.79)) than CCCPR patients (n = 1804). Subgroup analysis revealed that OCCPR was associated with a poorer outcome compared to CCCPR in patients with severe pelvis and lower extremity injury.ConclusionsIn this large cohort, OCCPR was associated with reduced in-hospital and 24-hour survival rates in patients with blunt trauma. Further comparisons between OCCPR and CCCPR using additional information, such as time course details in pre-hospital and ED settings, anatomical details regarding region of injury, and neurological outcomes, are necessary.Electronic supplementary materialThe online version of this article (doi:10.1186/s13054-017-1759-1) contains supplementary material, which is available to authorized users.

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Section: Discussionsupporting

confidence: 78%

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

et al. 2017

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“…Although there has long been the recognition that certain patients suffering traumatic arrest are “salvageable” if the cause for their cardiac arrest is rapidly treated (such as those with airway obstruction, tension pneumothorax, cardiac tamponade, or hypovolemia), it is also recognized that many prehospital traumatic arrest patients are transferred to hospitals under a “lights and sirens” approach, and undergo futile and costly resuscitation efforts, including resuscitative thoracotomies(8, 9). Guidelines have been developed to identify patients for whom resuscitation efforts should be withheld or terminated in the field(1) and emergency department settings(8-10).…”

Section: Introductionmentioning

confidence: 99%

“…Guidelines have been developed to identify patients for whom resuscitation efforts should be withheld or terminated in the field(1) and emergency department settings(8-10). Concurrently, narrative reviews proposing treatment algorithms for traumatic arrest patients have been published that emphasize the early treatment of reversible causes of arrest(11, 12) and selective use of resuscitative thoracotomy(8, 9). …”

Section: Introductionmentioning

confidence: 99%

Prehospital traumatic cardiac arrest

Evans

Petersen

Meier

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to: 1) Describe the management and outcomes of prehospital traumatic arrests; 2) Determine regional variation in survival; and 3) Identify Advanced Life Support (ALS) procedures associated with survival. Methods This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma registries. Patients were included if they suffered a blunt or penetrating injury and received CPR. Logistic regression analyses were used to determine the association between ALS procedures and survival. Results We included 2300 patients who were predominately young (Epistry mean: 39 years, SD: 20 years; PROPHET mean: 40 years, SD: 19 years), males (79%), injured by blunt trauma (Epistry: 68%, PROPHET: 67%), and treated by ALS paramedics (Epistry: 93%, PROPHET: 98%). A total of 145 patients (6.3%) survived to hospital discharge. More patients with blunt (Epistry 8.3%, PROPHET: 6.5%) vs. penetrating injuries (Epistry 4.6%, PROPHET: 2.7%) survived. Most survivors (81%) had vitals on EMS arrival. Rates of survival varied significantly between the 12 study sites (p=0.048) in the Epistry but not PROPHET (p=0.14) registries. PROPHET patients who received a supraglottic airway insertion or intubation experienced decreased odds of survival (Adjusted ORs: 0.27, 95% CI: 0.08-0.93, and 0.37, 95% CI: 0.17-0.78, respectively) compared to those receiving bag-mask ventilation. No other procedures were associated with survival. Conclusions Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on EMS arrival. Although limited by confounding and statistical power, no ALS procedures were associated with an increased odds of survival. Level of Evidence Level IV, prognostic study

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“…This topic was reviewed during the consensus development meeting, where it was strongly supported (95.0%) that bilateral thoracostomies should be performed instead of needle thoracocentesis in paediatric TCA 19. However, we acknowledge that needle thoracocentesis continues to be taught as the primary method of chest decompression on paediatric life support courses, and individuals may therefore elect to perform needle thoracocentesis ahead of thoracostomy 7…”

Section: Resultsmentioning

confidence: 99%

Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation

et al. 2018

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An evidence-based approach to patient selection for emergency department thoracotomy

Abstract: Systematic review/guideline, level III.

Cited by 268 publications

References 74 publications

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

Open-chest versus closed-chest cardiopulmonary resuscitation in blunt trauma: analysis of a nationwide trauma registry

Prehospital traumatic cardiac arrest

Paediatric traumatic cardiac arrest: the development of an algorithm to guide recognition, management and decisions to terminate resuscitation

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