Emergency clamshell thoracotomy in blunt trauma resuscitation: Shelling the paradigm‐2 cases and review of the literature

Schober, Patrick; Leeuw, Marcel A. de; Terra, Maartje; Loer, Stephan A.; Schwarte, Lothar A.

doi:10.1002/ccr3.1653

Cited by 7 publications

(6 citation statements)

References 21 publications

(24 reference statements)

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“…This measure has significance in the prehospital treatment of penetrating traumas. Nonetheless, no final recommendation can be given for patients with blunt trauma, due to the current lack of evidence, although a current study from the Netherlands postulates an advantage for patients with blunt trauma [29]. Prehospital volume administration for the maintenance of sufficient blood pressure levels, i.e., cerebral perfusion pressure after isolated TBI, would be another example for different procedures in patients with blunt trauma.…”

Section: Discussionmentioning

confidence: 99%

Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU®

Klein¹,

Lefering

Jungbluth³

et al. 2019

BioMed Research International

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Background. The impact of time (the golden period of trauma) on the outcome of severely injured patients has been well known for a long time. While the duration of the prehospital phase has changed only slightly (average time: ~66 min) since the TraumaRegister DGU® (TR-DGU®) was implemented, mortality rates have decreased within the last 20 years. This study analyzed the influence of prehospital time on the outcome of trauma patients in a matched-triplet analysis. Material and Methods. A total of 93,024 patients from the TraumaRegister DGU® were selected based on the following inclusion criteria: ISS ≥ 16, primary admission, age ≥ 16 years, and data were available for the following variables: prehospital intubation, blood pressure, mode of transportation, and age. The patients were assigned to one of three groups: group 1: 10-50 min (short emergency treatment time); group 2: 51-75 min (intermediate emergency treatment time); group 3: >75 min (long emergency treatment time). A matched-triplet analysis was conducted; matching was based on the following criteria: intubation at the accident site, rescue resources, Abbreviated Injury Scale (AIS) of the body regions, systolic blood pressure, year of the accident, and age. Results. A total of 4,617 patients per group could be matched. The number of patients with a GCS score ≤8 was significantly higher in the first group (group 1: 36.6%, group 2: 33.5%, group 3: 30.3%; p < 0.001). Moreover, the number of patients who had to be resuscitated during the prehospital phase and/or upon arrival at the hospital was higher in group 1 (p = 0.010); these patients also had a significantly higher mortality (group 1: 20.4%, group 2: 18.1%, group 3: 15.9%; p ≤ 0.001). The number of measures performed during the prehospital phase (e.g., chest tube insertion) increased with treatment time. Conclusions. The results suggest that survival after severe trauma is not only a matter of short rescue time but more a matter of well-used rescue time including performance of vital measures already in the prehospital setting. This also includes that rescue teams identify the severity of injuries more rapidly in the most-severely injured patients in critical condition than in less-severely injured patients and plan their interventions accordingly.

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Section: Discussionmentioning

confidence: 99%

Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU®

Klein¹,

Lefering

Jungbluth³

et al. 2019

BioMed Research International

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Section: Tension Pneumothoraxmentioning

confidence: 99%

“…The same approach is applied with a suspected critical hemothorax or hemopneumothorax. In selected cases, thoracostomies may be extended to a resuscitative thoracotomy (i.e., clamshell thoracotomy, exemplified in Figure 2) [6]. This figure depicts a typical aspect after a resuscitative thoracotomy, i.e., clamshell thoracotomy, with key aspects of the surgical access to the intrathoracic organs.…”

Section: Tension Pneumothoraxmentioning

confidence: 99%

“…Several reasons account for this, ranging from a better understanding of the pathophysiology of TCA, division into distinct TCA entities [2], separation from other causes of CA, refined guidelines [3], and also improved training [4] on this formerly potentially neglected topic [5]. In addition, technical advances in both diagnostics (e.g., point of care ultrasound, POCUS) and therapy [6] further reshape the management of TCA. Thus, although overall mortality of TCA is still very high [7], outcomes in selected subgroups are improving.…”

Section: Introductionmentioning

confidence: 99%

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Traumatic Cardiac Arrest—A Narrative Review

Schober,

Giannakopoulos,

Bulte

et al. 2024

JCM

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A paradigm shift in traumatic cardiac arrest (TCA) perception switched the traditional belief of futility of TCA resuscitation to a more optimistic perspective, at least in selected cases. The goal of TCA resuscitation is to rapidly and aggressively treat the common potentially reversible causes of TCA. Advances in diagnostics and therapy in TCA are ongoing; however, they are not always translating into improved outcomes. Further research is needed to improve outcome in this often young and previously healthy patient population.

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“…However, RT can also be used in a select cohort of blunt trauma patients with a view to provide thoracic aortic compression (to allow attempt of haemorrhage control below the diaphragm) and/or repair of clinically presumed organ injury within the chest cavity [ 3 , 4 , 7 ]. Whilst evidence for appropriateness and patient survival from prehospital blunt trauma RT is limited there are an increasing number of publications, incorporating both case studies and case series, showing survivors from the procedure both in the prehospital and hospital emergency department environments [ 8 – 12 ]. One case study reports a neurological intact survivor of a prehospital RT following blunt trauma [ 11 ].…”

Section: Introductionmentioning

confidence: 99%

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma

Almond

Morton

O’Meara

et al. 2022

Scand J Trauma Resusc Emerg Med

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Background Resuscitative thoracotomy (RT) is an intervention that can be performed in the prehospital setting for relieving cardiac tamponade and/or obtaining vascular control of suspected sub-diaphragmatic haemorrhage in patients in traumatic cardiac arrest. The aim of this retrospective case study is to compare the rates of return of spontaneous circulation (ROSC) in RTs performed for both penetrating and blunt trauma over 6 years in a mixed urban and rural environment. Methods The electronic records of a single helicopter emergency medical service were reviewed between 1st June 2015 and 31st May 2021 for RTs. Anonymised data including demographics were extracted for relevant cases. Data were analysed with independent t-tests and Χ2 tests. A p value < 0.05 was considered statistically significant. Results Forty-four RTs were preformed within the 6 years (26 for blunt trauma). Eleven ROSCs were achieved (nine blunt, two penetrating) but no patient survived to discharge. In contrast to RTs for penetrating trauma, twelve of the RTs for blunt trauma had a cardiac output present on arrival of the prehospital team (p = 0.01). Two patients had an RT performed in a helicopter (one ROSC) and two on a helipad (both achieving ROSC), likely due to the longer transfer times seen in a more rural setting. Four of the RTs for blunt trauma (15%) were found to have a cardiac tamponade versus seven (39%) of the penetrating trauma RTs. Conclusion Prehospital RT remains a procedure with low rates of survival but may facilitate a ROSC to allow patients to reach hospital and surgery, particularly when distances to hospitals are greater. A higher-than-expected rate of cardiac tamponade was seen in RTs for blunt trauma, although not caused by a right ventricular wound but instead due to underlying vessel damage.

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Emergency clamshell thoracotomy in blunt trauma resuscitation: Shelling the paradigm‐2 cases and review of the literature

Cited by 7 publications

References 21 publications

Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU®

Is Prehospital Time Important for the Treatment of Severely Injured Patients? A Matched-Triplet Analysis of 13,851 Patients from the TraumaRegister DGU®

Traumatic Cardiac Arrest—A Narrative Review

A 6-year case series of resuscitative thoracotomies performed by a helicopter emergency medical service in a mixed urban and rural area with a comparison of blunt versus penetrating trauma

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