Emergency thoracotomy in thoracic trauma—a review

Hunt, Paul; Greaves, Ian; Owens, W. Andrew

doi:10.1016/j.injury.2005.02.014

Cited by 172 publications

(132 citation statements)

References 65 publications

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“…7 Practice management guidelines for EDT have previously been published. 2,[8][9][10] There are no position statements or guidelines for performance of EDT from the Canadian Association of General Surgeons (CAGS) or Trauma Association of Canada (TAC), but the Western Trauma Association has published a 2012 consensus-based guideline suggesting current accepted indications for EDT (Table 1). 8 The merit of EDT has been questioned.…”

Section: Introductionmentioning

confidence: 99%

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Owen

Sne

Coates

et al. 2015

CJEM

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Objective: Emergency department thoracotomy (EDT) is a rare and potentially life-saving intervention performed for trauma patients in extremis. EDT is rare at Canadian trauma centres because of our infrequent occurrence of penetrating trauma. This study was undertaken to evaluate outcomes at a Canadian level 1 trauma facility and compare survival to large published datasets. Also, we evaluated the appropriateness of an EDT performed at our centre based on published national guidelines. Methods: Retrospective medical record review of all patients undergoing an EDT during their resuscitation in the emergency department. Records were identified using our trauma registry, and all charts were manually reviewed. The primary outcome was survival to hospital discharge. Results: Over a 20-year period, 58 EDTs were performed with 6 (10.3%) survivors. Patients undergoing an EDT secondary to penetrating trauma had the highest survival (5 of 24 patients or 20.8% survival) compared to patients undergoing an EDT for blunt trauma (1 of 34 patients or 2.9% survival). Patients undergoing an EDT who had not suffered cardiac arrest represented the group with the highest survival rate (3 of 6 patients or 50% survival). The majority of EDTs (79.3%) were indicated, and no patient undergoing an EDT survived if it was performed outside of published guidelines. Conclusions: Survival following an EDT in our small, regional trauma centre is consistent with survival rates from larger published datasets. An EDT should continue to be performed under accepted clinical indications. RÉSUMÉObjectifs: La thoracotomie pratiquée au service des urgences (TSU) est une intervention rare et potentiellement salvatrice chez les grands blessés qui arrivent dans un état gravissime au service des urgences (SU). La TSU est pratiquée rarement dans les centres de traumatologie en raison de la faible fréquence des traumas par pénétration. L'étude visait à évaluer les résultats de la TSU pratiquée dans un centre de traumatologie de niveau 1 au Canada et à comparer la survie à celle relevée dans de grands ensembles de données publiés. De plus, les auteurs voulaient évaluer la pertinence de la TSU pratiquée dans leur centre en fonction des lignes directrices nationales, publiées. Méthode: Il s'agit d'un examen rétrospectif des dossiers médicaux de tous les patients ayant subi une TSU durant les manoeuvres de réanimation au SU. La recherche des dossiers s'est faite à l'aide du registre des traumas de l'établissement concerné, et tous les dossiers ont fait l'objet d'un examen manuel. Le principal critère d'évaluation était la survie au moment de la sortie de l'hôpital. Résultats: Sur une période de 20 ans, 58 TSU ont été effectuées, dont 6 (10,3 %) se sont révélées fructueuses. Les patients ayant subi une TSU à la suite d'un trauma par pénétration ont connu le plus haut taux de survie (5 patients sur 24 ou taux de survie de 20,8 %) comparativement aux patients ayant subi une TSU à la suite d'un trauma contondant (1 patient sur 34 ou taux de survie de 2,9 %). ...

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Section: Introductionmentioning

confidence: 99%

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Owen

Sne

Coates

et al. 2015

CJEM

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“…In contrast to urgent thoracotomy, emergency thoracotomy is performed immediately in the emergency department as an integral part of the initial resuscitation process shortly after presentation (22). The indications for emergency thoracotomy were penetrating trauma in three patients in extremis (BP <60 mmHg; not responding to fluid resuscitation) on arrival to the ER.…”

Section: Discussionmentioning

confidence: 99%

Challenges in the Management of Penetrating Cardiac Injuries in Taiz, Yemen

Al-Ganadi¹

2015

YEM J SCI

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Ten patients with penetrating heart injury were admitted to the emergency room (ER) of Yemen International Hospital, Taiz, Yemen in the period 2011-2013. Nine patients were males and one was a female, with mean age of patients was 27.6 years old. All mechanisms of injuries were gunshot wounds except for one, which was a stab wound. Patients were classified into three groups according to their hemodynamic states and consciousness level. The first group includes five patients who were hemodynamically unstable and conscious. These patients were transferred immediately to the operating room. Patients with various heart injuries survived. The second group includes three patients who were in shock with no detectable blood pressure and semiconscious. Because there was no response to resuscitation, they were highly indicated for emergency thoracotomy, which could not be performed due to the presence of their firearmscarrying relatives in the ER. Therefore, these patients died. The third group includes two patients who were hemodynamically stable and conscious. They underwent pericardial window opening. In conclusion, penetrating cardiac injuries seen in our hospital are consistent with the available literature. However, it is believed that country security instability is one of the important factors that affects the management of such cases according to the international guidelines.

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“…En consecuencia, en el trauma torácico existen situaciones clínicas en las cuales la hemorragia y/o la alteración en la mecánica respiratoria son de tal magnitud que no existen medidas que permitan una reanimación eficiente, siendo esta la principal justificación para la indicación de una toracotomía de emergencia, y en la actualidad este procedimiento quirúrgico es considerado como parte de la reanimación inicial. 2 En el trauma torácico penetrante el sangrado puede ser evidente hacia el exterior; de la misma forma, la exanguinación también es posible en el trauma torácico contuso, donde la cavidad pleural puede albergar un gran volumen de sangre que es difícil de estimar sin un drenaje de toracostomía 11 , y rápidamente un hemitórax puede albergar más de la mitad de la volemia antes de que existan manifestaciones clínicas que hagan evidente el diagnós-tico de hemorragia intratorácica masiva. De esta manera, el examen clínico puede ser la única señal de una hemorragia grave intratorácica frente a un paciente que se presenta en shock, inquieto, agitado, taquicárdico, sudoroso, pálido y con vasoconstricción periférica (llene capilar lento).…”

Section: Discussionunclassified

“…La mayoría de ellos (90%) puede ser manejado con un tratamiento conservador, con o sin drenaje de toracostomía, sin embargo, un número menor de pacientes (10%) requieren de toracotomía de emergencia como parte del manejo inicial 2 .…”

Section: Introductionunclassified

Hernia de Morgagni: Reporte de un caso

G¹,

F²,

Delgado³

2006

Rev Chil Cir

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RESUMENEs nuestro objetivo comunicar un caso clínico del Hospital Clínico Herminda Martin, en el cual se realizó una reparación torácica con material protésico en un tiempo como consecuencia de un traumatismo penetrante torácico por arma de fuego con pérdida de pared, con buenos resultados.PALABRAS CLAVE: Trauma de tórax, reconstrucción, tiro SUMMARYWe report a 21 years old woman that was admitted in the emergency room due to a extensive chest trauma caused by a gunshot. The patient was subjected to an emergency thoracotomy. A right lung lower and middle lobectomy, partial hepatectomy, diaphragmatic suture and mastectomy were performed. A primary chest closure was done, using a Marlex prosthesis covered by a cutaneous flap. During the postoperative period, the patient had a surgical wound infection, that was treated conservatively and was discharged 42 days after surgery. INTRODUCCIÓNEl trauma es una de las principales causa de muerte en todos los grupos de edad, constituyendo el trauma torácico, penetrante y contuso el 25-50% de todos los traumas 1 . La mayoría de ellos (90%) puede ser manejado con un tratamiento conservador, con o sin drenaje de toracostomía, sin embargo, un número menor de pacientes (10%) requieren de toracotomía de emergencia como parte del manejo inicial 2 .La toracotomía de emergencia ha demostrado utilidad en la evacuación de un taponamiento cardíaco, el control directo de hemorragias intratorá-cicas, el control de una embolia aérea masiva, el masaje cardíaco abierto, así como el clampeo se-

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Emergency thoracotomy in thoracic trauma—a review

Cited by 172 publications

References 65 publications

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Outcomes of emergency department thoracotomy in a tertiary care Canadian trauma centre

Challenges in the Management of Penetrating Cardiac Injuries in Taiz, Yemen

Hernia de Morgagni: Reporte de un caso

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