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

Abstract

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 %). ...

Sign of Life is Associated with Return of Spontaneous Circulation After Resuscitative Thoracotomy: Single Trauma Center Experience of Republic of Korea

“…Our results demonstrate that 4.8% of patients who were discharged had survived, which is a low proportion but comparable with outcomes in previous studies, which demonstrated overall survival of 7-10% [12,13]. In blunt trauma, RT remains controversial.…”

“…The baseline characteristics are presented in Table 1. The ROSC group presented shorter CPR times than the non-ROSC group (6 [2-10] min vs 11 [8][9][10][11][12] min, p \ 0.001), more presence of sign of life in the trauma bay (32 (86.5%) vs 7 (28.0%), p \ 0.001), and less ISS (26 [25-39] vs 37 [30-75], p = 0.038). However, ISS could not be calculated for nine patients in each group because adequate evaluation was not performed.…”

Outcomes of emergency thoracotomy for trauma in a general hospital in Singapore

“…Previous studies were case reports of a single survivor or retrospective reviews of outcomes of ED thoracotomy internationally. 8 These data can be used to aid in the development of local guidelines on the indications for emergency thoracotomy and reduce unnecessary procedures in the future.…”

Compliance of tranexamic acid administration to trauma patients at a level-one trauma centre

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