Improving survival after an emergency resuscitative thoracotomy: a 5-year review of the Trauma Quality Improvement Program

Abstract

BackgroundAdvancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT.MethodsA 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed.Results2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism.DiscussionUtilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided.Level of evidenceLevel III, prognostic studies.

Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study

“…The differences in these factors might have largely affected the survival rate observed in the present study (13.0% in the overall study cohort), which was higher than that of previously reported [23][24][25][26]. Joseph et al [27] reviewed patients who underwent exploratory thoracotomy (ICD-9-CM, 34.02) within the first hour of hospital admission using the TQIP database and reported 9.6% survival rate. However, their study included patients without SOL on hospital arrival (28.6% of the analyzed cohort).…”

“…Joseph et al [ 27 ] reviewed patients who underwent exploratory thoracotomy (ICD-9-CM, 34.02) within the first hour of hospital admission using the TQIP database and reported 9.6% survival rate. However, their study included patients without SOL on hospital arrival (28.6% of the analyzed cohort).…”

Clamshell in a Heartbeat

“…2 Second, young age and penetrating injury are favorable factors for an improved neurologic outcome in case of traumatic cardiac arrest. 6 The anatomic location and mechanism of injury are independent predictors of survival. 6 Damage control surgery focuses on resolving life-threatening situations and does not involve complete evaluation of all organs if not directly indicated.…”

“…6 The anatomic location and mechanism of injury are independent predictors of survival. 6 Damage control surgery focuses on resolving life-threatening situations and does not involve complete evaluation of all organs if not directly indicated. After damage control surgery, focus shifts to stabilization in the ICU before any other procedures are indicated.…”

Resuscitative Endovascular Balloon Occlusion of the Aorta: Review of the Literature and Applications to Veterinary Emergency and Critical Care

“…REBOA has recently re-gained popularity as an alternative to resuscitative thoracotomy (RT, thoracotomy and aortic cross-clamping) in trauma patients (2–8). RT has been associated with low survival rates (9, 10) and presents significant risks of injuries for care providers themselves. Furthermore, while RT may provide hemorrhage control, the thoracotomy itself adds a substantial injury to the patient with considerable recovery time.…”