Emergency thoracotomy in an urban community hospital: Initial cardiac rhythm as a new predictor of survival

Brautigan, Mark W.; Tietz, Gregory

doi:10.1016/0735-6757(85)90053-1

Cited by 18 publications

(4 citation statements)

References 9 publications

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“…An astonishing 47 thoracotomies as an emergency were performed in an urban community hospital in Detroit in a 1 year period [26] -28% survived; they describe the presenting cardiac rhythm as a prognostic factor with just over half of the patients being in sinus rhythm or sinus tachycardia and all survivors were in this group -no patient presenting with bradycardia, asytole or ventricular fibrillation survived. Further excellent results from penetrating cardiac injury [27] reported a 57% ( 21/37) survival after EDT -most of the deaths were in those suffering cardiac gunshot wounds -a further 24/27 (89%) survived OR thoracotomy giving an overall survival after penetrating cardiac injury of 70%.…”

Section: Incisionmentioning

confidence: 99%

Emergency Thoracotomy – The Indications, Contraindications and Evidence

Garner

2009

J R Army Med Corps

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Section: Incisionmentioning

confidence: 99%

Emergency Thoracotomy – The Indications, Contraindications and Evidence

Garner

2009

J R Army Med Corps

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“…36–39 It is also clear, however, that the vast majority of patients in traumatic cardiac arrest that receive thoracotomy do not survive. 40–45 So what features should be present to consider thoracotomy for blunt trauma? Firstly data from PHC is lacking so evidence is based upon in-hospital experience.…”

Section: Circulationmentioning

confidence: 99%

“…46 Furthermore, the combination of a traumatic head injury with thoracic trauma is a major determinant of adverse outcome after thoracotomy for blunt trauma where most survivors have a poor neurological outcome. 36,38,41,47 Amongst studies reporting which injuries are survivable after blunt trauma nearly half of patients are reported to have pericardial tamponade. 36–38,48 Overall, after removing patients with signs of life upon arrival at the ED the probability of mortality in the setting of thoracotomy for blunt trauma is 1 (95% CI 0.99–1).…”

Section: Circulationmentioning

confidence: 99%

The role for surgery in pre-hospital care

Roberts

2015

Trauma

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Pre-hospital care requires a broad skillset. One of the most challenging aspects of pre-hospital care is performing surgical procedures. The indications and evidence for performing pre-hospital surgical airway, thoracostomy, thoracotomy, caesarean section and amputation are discussed. Where evidence for the procedure is lacking from pre-hospital care, evidence from in-hospital experience is sought.

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“…First performed in 1900, resuscitative thoracotomy with aortic cross-clamping (RTACC) is the current standard and most commonly performed intervention following NCTH, despite being hugely invasive with significant associated complications. 4,5 Resuscitative endovascular balloon occlusion of the aorta (REBOA) is a less invasive method of aortic occlusion, first reported during the Korean War in 1954. It feeds an endovascular balloon into the aorta via the femoral artery; it can then be inflated to occlude distal flow in the aorta, limiting haemorrhage and maintaining central perfusion.…”

Section: Introductionmentioning

confidence: 99%

A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

Renna

Zeller

Abu-Hijleh

et al. 2017

Trauma

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Introduction: Major trauma is a leading cause of death and disability in young adults, especially from massive noncompressible torso haemorrhage. The standard technique to control distal haemorrhage and maximise central perfusion is resuscitative thoracotomy with aortic cross-clamping (RTACC). More recently, the minimally invasive technique of resuscitative endovascular balloon occlusion of the aorta (REBOA) has been developed to similarly limit distal haemorrhage without the morbidity of thoracotomy; cost-utility studies on this intervention, however, are still lacking. The aim of this study was to perform a one-year cost-utility analysis of REBOA as an intervention for patients with major traumatic non-compressible abdominal haemorrhage, compared to RTACC within the U.K.'s National Health Service. Methods: A retrospective analysis of the outcomes following REBOA and RTACC was conducted based on the published literature of survival and complication rates after intervention. Utility was obtained from studies that used the EQ-5D index and from self-conducted surveys. Costs were calculated using 2016/2017 National Health Service tariff data and supplemented from further literature. A cost-utility analysis was then conducted. Results: A total of 12 studies for REBOA and 20 studies for RTACC were included. The mean injury severity scores for RTACC and REBOA were 34 and 39, and mean probability of death was 9.7 and 54%, respectively. The incremental costeffectiveness ratio of REBOA when compared to RTACC was £44,617.44 per quality-adjusted life year. The incremental cost-effectiveness ratio, by exceeding the National Institute for Health and Clinical Effectiveness's willingness-to-pay threshold of £30,000/quality-adjusted life year, suggests that this intervention is not cost-effective in comparison to RTACC. However, REBOA yielded a 157% improvement in utility with a comparatively small cost increase of 31.5%. Conclusion: Although REBOA has not been found to be cost-effective when compared to RTACC, ultimately, clinical experience and expertise should be the main factor in driving the decision over which intervention to prioritise in the emergency context.

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Emergency thoracotomy in an urban community hospital: Initial cardiac rhythm as a new predictor of survival

Cited by 18 publications

References 9 publications

Emergency Thoracotomy – The Indications, Contraindications and Evidence

Emergency Thoracotomy – The Indications, Contraindications and Evidence

The role for surgery in pre-hospital care

A one-year cost–utility analysis of REBOA versus RTACC for non-compressible torso haemorrhage

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