The use of emergency department thoracotomy for traumatic cardiopulmonary arrest

Seamon, Mark J.; Chovanes, John; Fox, Nicole; Green, Raymond; Manis, George; Tsiotsias, George; Warta, Melissa; Ross, Steven E.

doi:10.1016/j.injury.2012.04.011

Cited by 59 publications

(26 citation statements)

References 80 publications

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“…Type of injury was identified as a confounding variable because it has previously been shown to be associated with outcome from traumatic arrest(1, 8, 22) and we felt this could influence whether EMS providers perform critical procedures or transport patients to the hospital. ROC study site was adjusted for as a way to control for unmeasured confounders at the research site level.…”

Section: Methodsmentioning

confidence: 99%

Prehospital traumatic cardiac arrest

Evans

Petersen

Meier

et al. 2016

Journal of Trauma and Acute Care Surgery

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Background Traumatic arrests have historically had poor survival rates. Identifying salvageable patients and ideal management is challenging. We aimed to: 1) Describe the management and outcomes of prehospital traumatic arrests; 2) Determine regional variation in survival; and 3) Identify Advanced Life Support (ALS) procedures associated with survival. Methods This was a secondary analysis of cases from the Resuscitation Outcomes Consortium Epistry-Trauma and Prospective Observational Prehospital and Hospital Registry for Trauma registries. Patients were included if they suffered a blunt or penetrating injury and received CPR. Logistic regression analyses were used to determine the association between ALS procedures and survival. Results We included 2300 patients who were predominately young (Epistry mean: 39 years, SD: 20 years; PROPHET mean: 40 years, SD: 19 years), males (79%), injured by blunt trauma (Epistry: 68%, PROPHET: 67%), and treated by ALS paramedics (Epistry: 93%, PROPHET: 98%). A total of 145 patients (6.3%) survived to hospital discharge. More patients with blunt (Epistry 8.3%, PROPHET: 6.5%) vs. penetrating injuries (Epistry 4.6%, PROPHET: 2.7%) survived. Most survivors (81%) had vitals on EMS arrival. Rates of survival varied significantly between the 12 study sites (p=0.048) in the Epistry but not PROPHET (p=0.14) registries. PROPHET patients who received a supraglottic airway insertion or intubation experienced decreased odds of survival (Adjusted ORs: 0.27, 95% CI: 0.08-0.93, and 0.37, 95% CI: 0.17-0.78, respectively) compared to those receiving bag-mask ventilation. No other procedures were associated with survival. Conclusions Survival from traumatic arrest may be higher than expected, particularly in blunt trauma and patients with vitals on EMS arrival. Although limited by confounding and statistical power, no ALS procedures were associated with an increased odds of survival. Level of Evidence Level IV, prognostic study

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Section: Methodsmentioning

confidence: 99%

Prehospital traumatic cardiac arrest

Evans

Petersen

Meier

et al. 2016

Journal of Trauma and Acute Care Surgery

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“…Ist eines dieser 4 Kriterien nicht erfüllt, so ist eine RT aussichtslos und gefährdet nur das Team [193].…”

Section: "Elapsed Time" (Zeitverzögerung)unclassified

Kreislaufstillstand in besonderen Situationen

Truhlář

Deakin

Soar

et al. 2015

Notfall Rettungsmed

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“…La toracotomía de urgencia en box ha sido considerada como una opción de resucitación frente a pacientes que ingresan a urgencias sin signos vitales, sin embargo, su supervivencia no supera el 21% 4,5,10,26 . Numerosas publicaciones se han dedicado a buscar predictores de supervivencia en pacientes reanimados con una toracotomía de urgencia en box, demostrándose una mayor resucitación y supervivencia en traumatismo penetrante versus contuso 4,5,21 .…”

Section: Discussionunclassified

Traumatismo penetrante cardiaco: caracterización, resultados inmediatos y variables asociadas a morbilidad y mortalidad en pacientes operados

González

Riquelme²,

Fuentes³

et al. 2019

Rev. cir.

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Penetrating cardiac trauma: findings, outcomes and prognostic factors in operated patients Introduction: Penetrating cardiac trauma (PCT) constitute a permanent surgical challenge due to it characteristics and high mortality. Aim: To describe the findings, outcomes and prognostic factors in PCT. Materials and Method: Cross-sectional descriptive study, review of prospective thoracic trauma protocols and surgical registries. Period January 1990-December 2017. All patients with PCT were included. Various variables are described and analyzed. Univariate and multivariate analysis were performed to identify factors associated with morbidity, neurologic dysfunction and mortality. Results: 220 patients PCT, 209 (95.0%) men, mean age 30.4 ± 13.3, median 27 years. Mechanism: Aggression in 202 (91.8%). The traumatic agent was cold steel in 186 (84.4%) and fire arm in 21 (9.5%). 169 (76.8%) patients presented with tamponade, 103 (46.8%) shock and 20 (9.1%) cardiopulmonary arrest. Approach was sternotomy in 157 (71.4%), left thoracotomy in 58 (26.4%). The most common injured areas were right ventricle in 110 (50.0%), left ventricle in 72 (32.7%). 135 (61.4%) patients needed postoperative ICU and 74 (33.6%) were transfused. Complications occurred in 60 (27.3%). Twenty-one (9.5%) were reoperated. Mortality 28 (12.7%). The postoperative median stay was 6 days (Range 1-150). Prognostic factors were identified. Discussion: Operated PCT are more frequent in men with stab wound, the most common injured area is the right ventricle. The morbidity and mortality is comparable with international series.

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The use of emergency department thoracotomy for traumatic cardiopulmonary arrest

Cited by 59 publications

References 80 publications

Prehospital traumatic cardiac arrest

Prehospital traumatic cardiac arrest

Kreislaufstillstand in besonderen Situationen

Traumatismo penetrante cardiaco: caracterización, resultados inmediatos y variables asociadas a morbilidad y mortalidad en pacientes operados

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