Efficacy of emergency room thoracotomy in pediatric trauma

Beaver, Bonnie L.; Colombani, Paul M.; Buck, James R.; Dudgeon, David; Bohrer, Stuart; Haller, Julia A.

doi:10.1016/s0022-3468(87)80007-6

Cited by 69 publications

(23 citation statements)

References 14 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…82 Thirty-six patients suffered an out-of-hospital traumatic cardiopulmonary arrest from penetrating injuries, and at least 9 of them had a resuscitative thoracotomy in an ED; all of these patients died regardless of whether thoracotomy was performed. 3,[50][51][52]68 Resuscitative thoracotomy was performed at the scene, in the ED, or in the operating room, for 30 patients (combined blunt and penetrating trauma victims) who suffered an out-of-hospital traumatic cardiopulmonary arrest, and there were no survivors. 3,50-52 A few published articles mentioned children who were declared dead in the field, implying that the state or country has a do-not-resuscitate protocol for a subset of arrest victims.…”

Section: Determine Location Of Arrest (Outof-hospital or Emergency Dementioning

confidence: 99%

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Fallat¹,

Cooper²,

Salomone³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

This multiorganizational literature review was undertaken to provide an evidence base for determining whether recommendations for outof-hospital termination of resuscitation could be made for children who are victims of traumatic cardiopulmonary arrest. Although there is increasing acceptance of out-of-hospital termination of resuscitation for adult traumatic cardiopulmonary arrest when there is no expectation of a good outcome, children are routinely excluded from state termination-of-resuscitation protocols. The decision to withhold resuscitative efforts in a child under specific circumstances (decapitation or dependent lividity, rigor mortis, etc) is reasonable. If there is any doubt as to the circumstances or timing of the traumatic cardiopulmonary arrest, under the current status of limiting termination of resuscitation in the field to persons older than 18 years in most states, resuscitation should be initiated and continued until arrival to the appropriate facility. If the patient has arrested, resuscitation has already exceeded 30 minutes, and the nearest facility is more than 30 minutes away, involvement of parents and family of these children in the decision-making process with assistance and guidance from medical professionals should be considered as part of an emphasis on family-centered care because the evidence suggests that either death or a poor outcome is inevitable. Pediatrics 2014;133:e1104-e1116

show abstract

Section: Determine Location Of Arrest (Outof-hospital or Emergency Dementioning

confidence: 99%

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Fallat¹,

Cooper²,

Salomone³

et al. 2014

Pediatrics

View full text Add to dashboard Cite

show abstract

“…The first study to examine whether EDT for paediatric patients was in any way different from in adults was published in 1987 [71] -over a 5 year period 17 paediatric trauma victims underwent EDT -15 for multisystem blunt injury and two for isolated penetrating trauma -there were no survivors. The Denver group published a subset analysis of their prospective database in 1989 having identified 83 EDTs performed on under 18's [72].…”

Section: Paediatric Thoracotomymentioning

confidence: 99%

Emergency Thoracotomy – The Indications, Contraindications and Evidence

Garner

2009

J R Army Med Corps

View full text Add to dashboard Cite

show abstract

“…Survival has repeatedly been demonstrated to be poor in this age group. There are several studies that report 0% survival[8, 12]. These small case series only include 17 and 9 patients respectively.…”

Section: Discussionmentioning

confidence: 99%

Pediatric emergency department thoracotomy: A 40-year review

Moore

Bensard

2016

Journal of Pediatric Surgery

View full text Add to dashboard Cite

Background/purpose Emergency department thoracotomy (EDT) has been proposed to be futile in the pediatric patient population. This extreme procedure has survival rates of 0 to 26% in the non-adult population. When taking into consideration that the mechanism of injury is one of the strongest predictors of survival, we hypothesize that the low survival rate in pediatric patients is attributable to a higher rate of blunt trauma compared to their adolescent counterparts. Methods Prospective data collected from our level 1 trauma center from 1974 - 2014 on all patients undergoing EDT at our institution was evaluated for age 18 or younger. Patient predictor variables included injury mechanism, injury pattern, and detected cardiac activity in the field. Outcomes included successful resuscitation (re-establish of blood pressure and taken to operating room) and overall survival. Patients were dichotomized by age into pediatric (age ≤ 15 yrs) and adolescent (16-18yrs) categories. Results 1691 patients who underwent EDT were evaluated for age of 18 or less, which included 179 patents (11%). Overall survival in the adult population was 6.1%, compared to 3.4% in the non-adult population (p=0.157). Pediatric patients were more likely to sustain blunt injury than adolescents (72% vs 32% p<0.001). This also corresponded to differences in anatomic injury patterns and more multisystem trauma (52% vs 44% p=0.001). Adolescents had significantly higher survival rates than pediatric patients (5% vs 0% p=0.036). Conclusion In non-adult patients undergoing EDT, adolescents have a higher survival rate than pediatric patients. The pediatric population had a significantly lower incidence of penetrating trauma and higher incidence of head injury. The discrepancy in survival between adolescent and pediatric patients appears to be attributable due to differences in mechanism. Therefore, those pediatric patients with penetrating thoracic injuries may still benefit from EDT.

show abstract

Efficacy of emergency room thoracotomy in pediatric trauma

Cited by 69 publications

References 14 publications

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Withholding or Termination of Resuscitation in Pediatric Out-of-Hospital Traumatic Cardiopulmonary Arrest

Emergency Thoracotomy – The Indications, Contraindications and Evidence

Pediatric emergency department thoracotomy: A 40-year review

Contact Info

Product

Resources

About