Emergency thoracotomy in the pre-hospital setting: a procedure requiring clarification☆

Abstract

Our study has shown that when confounding variables are accounted for, ET is not a predictor of mortality following severe chest trauma. This implies that in a well-selected group of patients it may be a significant and life-saving procedure.

Emergency Thoracotomy – The Indications, Contraindications and Evidence

“…Again those with signs of life at the scene did better with the survivors equally divided between those who lost their pulse prior to arrival of the HEMS team (they received 4 and 5 minutes of basic bystander life support respectively) and those who lost output after the HEMS team arrived. The most recent analysis of HEMS data reported on 8 years of HEMS flights for 670 consecutive cases of major thoracic injury -emergency thoracotomy was performed in 53 with an overall 18% survival; this was 3/31 on scene and 7/22 in the EDT or OR but unfortunately the paper does not discriminate further between these two groups [7]. The Department of Surgery in Baragwanath Hospital South Africa [59] reported a massive series of 846 EDTs over a 12 year period with survival in 26/312 stab wounds (8.3%), 16/358 (4.4%) and 1/176 (0.6%) although no clear distinction is made between which surgeries were true EDTs and which were undertaken in the OR.…”

“…Most thoracic trauma deaths occur within the first three hours from great vessel or cardiac disruption. In the UK, one third of all patients attended to by the London Helicopter Emergency Medical Services (HEMS) have suffered thoracic injury requiring specialist intervention [7]. Blunt thoracic trauma -mainly from Road Traffic Collisions -predominates in Europe with interpersonal violence accounting for only 5% of cases [8].…”

Thoracotomy in Thoracic Injuries: Results from a Tertiary Referral Hospital

“…As reported by Athanassiou et al [6], age > 60 years, a GCS of less than eight at the scene, the need for intubation at the scene, low saturation level at admittance, a bilateral injury, and a hemothorax are among the factors that worsen survival after a thoracic injury. In patients undergoing thoracotomy, undetectable blood pressure, lower GCS, higher ISS, a penetrating injury type, a lack of signs of life, and massive blood transfusion are significant factors that increase mortality [6,17,18,27]. Such factors were all investigated in this study, and it was found that a lower GCS and a higher ISS affected the survival negatively (p = 0.02, and p = 0.05, respectively).…”

“…The incidence of thoracotomy after any thoracic injury varies between 2.4 and 22% [3,[6][7][8]. Less than 10% of patients with blunt thoracic injury require a thoracotomy [3,9,10].…”

“…The survival rates for both penetrating and blunt types of thoracic injury were higher than those in previous series. This can be explained by the fact that none of the patients were intubated at the scene, had undetectable blood pressure or a lack of signs of life on admission, which are the major factors that worsen survival [6,17,18,27].…”