Emergency thoracotomies in traumatic cardiac arrests following blunt trauma – experiences from a German level I trauma center

Abstract

Purpose Resuscitative thoracotomies (RT) are the last resort to reduce mortality in patients suffering severe trauma. In recent years, indications for RT have been extended from penetrating to blunt trauma. However, discussions on efficacy are still ongoing, as data on this rarely performed procedure are often scarce. Therefore, this study analyzed RT approaches, intraoperative findings, and clinical outcome measures following RT in patients with cardiac arrest following blunt trauma. Methods All patients admitted to our level I trauma center's emergency room (ER) who underwent RT between 2010 and 2021 were retrospectively analyzed. Retrospective chart reviews were performed for clinical data, laboratory values, injuries observed during RT, and surgical procedures. Additionally, autopsy protocols were assessed to describe injury patterns accurately. Results Fifteen patients were included in this study with a median ISS of 57 (IQR 41–75). The 24-h survival rate was 20%, and the total survival rate was 7%. Three approaches were used to expose the thorax: Anterolateral thoracotomy, clamshell thoracotomy, and sternotomy. A wide variety of injuries were detected, which required complex surgical interventions. These included aortic cross-clamping, myocardial suture repairs, and pulmonary lobe resections. Conclusion Blunt trauma often results in severe injuries in various body regions. Therefore, potential injuries and corresponding surgical interventions must be known when performing RT. However, the chances of survival following RT in traumatic cardiac arrest cases following blunt trauma are small.

Traumatic Cardiac Arrest—A Narrative Review

“…As with resuscitation of TCA, also the traditional dogma of 'futility of emergency thoracotomies' has to be abandoned, certainly for indications such a single thoracic stab wounds. Studies demonstrate survival rates from severe trauma-related emergency thoracotomies from 7% in blunt trauma [53] to more than 50% [54] in not yet arrested patients.…”