Emergency department thoracotomy in Jamaica: A case controlled study

Abstract

Increasing numbers of severely injured patients have been presenting to Emergency Rooms worldwide due to advances in pre-hospital trauma care. Some of these patients may be candidates for Emergency Department Thoracotomy (EDT). Large advisory bodies have identified selection criteria for EDT in Developed Countries, but there are no regional statistics to guide the selection process in Developing Caribbean Nations. This study evaluates outcomes with EDT at the University Hospital of the West Indies in Jamaica in order to determine factors that could predict survival in this setting. A retrospective study was performed over 11 years from January 1995 to January 2006 examining patients who had EDT at the University Hospital of the West Indies. There were 13 procedures performed over 11 years, with two early survivors (15%) and one patient surviving to discharge. The factors that have been found to be significant predictors of mortality include gunshot injuries, extra-thoracic injury location, inadequate pre-hospital resuscitation, prolonged transportation time and the absence of signs of life on arrival to hospital. Several health care limitations have been uncovered in this setting that must be improved if we are to expect improved outcomes. Focused preparation of the Emergency Room is an initial step that can be easily achieved. We also need to define strict management protocols using selection criteria that are tailored to our local environment in order to exclude futile procedures in unsalvageable patients.

CARDIAC SURGERY Penetrating cardiac injuries: 28-year data analysis

“…In agreement with others, our results have shown that victims of penetrating cardiac injuries are predominantly young males [1,3,14,16,20,24,25,30].…”

“…It was found in 82.4% of survivors and 42.9% of non-survivors, p < 0.001. Some authors also conclude that the more SOL found on admission the greater opportunity to survive [20,22,27].…”

“…For the rest the operation was delayed due to numerous reasons. In some clinics and hospitals patients with suspected heart injury were being operated on at the emergency department operating room [4,14,20,22,27]. All the patients in our series were operated on in the operating theatre of the Department of General Thoracic Surgery.…”

“…Signs of life were defined by the presence of any of the following: measurable blood pressure, palpable carotid pulse, pupillary response, spontaneous breathing efforts, and extremity movements (according to American College of Surgeons Committee on Trauma six estimated signs) [20]. However, we were unable to include the sixth sign, cardiac electrical activity, since this examination in some patients was not performed on admittance due to unknown reasons.…”

Technical note: rapid, large-volume resuscitation at resuscitative thoracotomy by intra-cardiac catheterization

“…With penetrating trauma reaching epidemic proportions in the Caribbean [1], emergency room (ER) thoracotomies are performed regularly [2]. It may be life-saving by achieving four goals: (i) releasing cardiac tamponade, (ii) controlling haemorrhage, (iii) allowing access for internal cardiac massage and (iv) clamping the descending aorta to isolate circulation to the upper torso in damage control surgery [3, 4].…”