Emergency thoracotomies: Two center study

Abstract

Introduction and Aim:Emergency thoracotomy is performed either immediately at the scene of injury, in the emergency department or in the operating room. It aims to evacuate the pericardial tamponade, control the haemorrhage, to ease the open cardiac massage and to cross-clamp the descending thoracic aorta to redistribute blood flow and maybe to limit sub-diaphragmatic haemorrhage, bleeding and iatrogenic injury are the common risk factors. We aimed to review our experience in the field of emergency thoracotomies, identify the predictors of death, analyze the early results, detect the risk factors and asses the mortalities and their risk factors.Patients and Methods:Our hospital records of 197 patients who underwent emergency thoracotomy were reviewed. We retrospectively analyzed a piece of the extensive experience of the Mansoura University Hospitals and Mansoura Emergency Hospital; Egypt and Saudi German Hospitals; Jeddah in the last 12 years in the management of trauma cases for whom emergency thoracotomy. The aim was to analyse the early results of such cases and to detect the risk factors of dismal prognosis.Results:Our series included 197 cases of emergency thoractomies in Mansoura; Egypt and SGH; Jeddah; KSA in the last 12 years. The mean age of the victims was 28 years and ranged between 5 and 62 years. Of the 197 patients with emergency thoracotomy, the indications were both penetrating and blunt chest trauma, iatrogenic and postoperative hemodynamito a surgical cause. The commonest indication was stab heart followed by traumatic diaphragmatic ruptures.Conclusion:The results of emergency thoracotomy in our series were cooping with the results of other reports, mainly due to our aggressive measures to achieve rapid stabilization of the hemodynamic condition. We emphasize the importance of emergency medicine education programs on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support. Emergency thoracotomy has an important role in emergency big volume hospitals and can save a lot of lives. Outcome can be improved by increasing the learning curve and the integrated cooperation of the emergency and surgical teams.

Clamshell thoracotomy and open heart massage—A potential life-saving procedure can be taught to emergency physicians

“…However unexpected survivors from traumatic cardiac arrest are clearly described with good neurological outcomes in both adult and paediatric practice [3,5,11,[25][26][27][28][29]. Indeed in patients with penetrating cardiac wounds survival is now around 7.5-30%, higher than medical cardiac arrest overall and similar to witnessed VT/VF with immediate bystander CPR [3,5,[7][8][9][10]30].…”

Occurrence of penetrating chest and hearts injury following assaults: a presentation of two cases

“…They go on to say that emergency thoracotomy has an important role in emergency big volume hospitals and can save a lot of lives. 11 Our two patients were Cardiac penetration patients and fortunately the grater vessels were missed. We followed the recommend facts of the Advanced Trauma life support (ATLS) guidelines and emergency thoracotomy in penetrating thoracic injuries based on their rules.…”

“…We followed the recommend facts of the Advanced Trauma life support (ATLS) guidelines and emergency thoracotomy in penetrating thoracic injuries based on their rules. 11 One typical reason is what Ordog GJ et al 12 found out: Of the four among their patients with initially unsuspected cardiac injuries, two patients died in the operating room. These were Asymptomatic patients with normal findings on chest x-ray films.…”

“…All patients should have close outpatient follow-up, these are the patients who develop pleural or Pericardial effusion. [9][10][11][12] Cardiac injuries analysis is highly important: Cardiac injury has traditionally been considered to be a positive prognostic factor, compared to findings of non-cardiac thoracic or abdominal injuries. A meta-analysis by Rhee, et al determined that survival rates were highest for isolated penetrating cardiac injuries (19%) compared to penetrating non-cardiac thoracic (11%)-This is particularly so if the greater Vessels are the major damages.…”

“…In a patient with a foreign body is left in the Chest after a stab, it is better to leave that foreign body impacted into the chest until emergency room can do a thoracotomy for life salvage. 11 This is because of a known fact that Injury to vital structures, including the heart and great vessels, often leads to rapid death. Rao R. Ivatury et al state that the early arrival of trained evacuation units at the scene of injury, better supportive therapy while at the site, and rapid transport of victims to designated hospitals had made it a possible chance of an improved survival for heart perforation of heart patients.…”