Authors: Mark J Seamon Carol A Fisher John P Gaughan Heather Kulp Daniel T Dempsey Amy J Goldberg
Publish Date: 2008/01/26
Volume: 32, Issue: 4, Pages: 604-612
Abstract
Although emergency department thoracotomy EDT is often considered a controversial “last chance” method of resuscitation we hypothesized that EDT performed in a busy urban Level I trauma center has significant salvage rates despite the absence of traditional survival predictors A retrospective review revealed that 180 patients underwent EDT after traumatic arrest for penetrating injury between 2000 and 2005 All were deemed nonsalvageable by other resuscitation methods Injury mechanism and location signs of life SOLs initial cardiac rhythm and presence of vital signs were analyzed In total 23 patients survived hospitalization neurologically intact Compared to nonsurvivors survivors more often suffered multiple stab wounds 217 vs 19 p = 0001 presented with field 957 vs 726 p = 0016 and ED 870 vs 605 p = 0014 SOLs had sustainable cardiac rhythms sinus tachycardia 435 vs 102 p = 0001 normal sinus rhythm 174 vs 45 p = 0037 and had measurable vital signs 652 vs 255 p = 0001 However only 3 of 23 130 survivors had all survival predictors and one survivor had none Frequent predictors in survivors were field SOLs 957 ED SOLs 870 salvageable initial cardiac rhythms 783 and obtainable vital signs 652 Stabbing mechanism 304 and cardiac injury location 304 were least common Had a strict policy of EDT performance based solely on the presence of survival predictors been followed and EDT withheld several patients who ultimately survived would have died Our study suggests that EDT is a technique that should be utilized for patients with critical penetrating injuries even in the absence of many traditional survival predictors
Keywords: