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

Abstract

Background An emergency thoracotomy can be performed either immediately at the site of trauma or in the emergency department or operating room for resuscitation of patients in extremis or life-saving treatment for patients with thoracic injury. It remains a procedure associated with high mortality rates, and there is a paucity of data from Asia. This study analyzed our six-year experience of emergency trauma thoracotomy in an acute general hospital in Singapore. Methods This retrospective analysis was based on experience in a single institution with all emergency trauma thoracotomies performed by general surgeons. All patients who underwent an emergency trauma thoracotomy in Khoo Teck Puat Hospital between January 2011 and December 2016 were studied. Data collected included patient demographics, mechanism of injury, Injury Severity Scores, surgical approach, and postoperative outcomes. Results Twenty-three patients underwent an emergency thoracotomy, 8 in the emergency department and 15 in the operating room. The mechanism of injury was blunt in 20 (87%) patients and penetrating in 3 (13%), with road traffic accidents the most common cause (70%). Six (40%) patients who underwent an emergency thoracotomy in the operating room survived beyond 24 h, and 4 (27%) survivors were eventually discharged from the hospital with no neurological deficit. No patient who underwent a thoracotomy in the emergency department survived beyond 24 h. Conclusions Emergency thoracotomy is associated with high mortality rates, especially when required in the emergency department or for blunt trauma. Nevertheless, it is a potentially life-saving procedure that offers a chance of survival in selected patients.

Penetrating and blunt injuries of the heart - an abdominal surgeon’s personal experience in Serbia

“…Fear of being sued in case of failure, is the most frequent reason for referring chest trauma to more specialized centers and staff [24]. In recent years some authors published results with intent to encourage general surgeons to engage in cardiac trauma [24], and emergency thoracotomy in general [24,25]. Doll and colleagues in their work stated, that in all cardiac wounds they applied a simple direct suture of the heart wall, highlighting that there was no need for an expertise of a cardiac surgeon nor extracorporeal circulation.…”