Emergency Department Thoracotomy: Survival of the Least Expected

Seamon, Mark J.; Fisher, Carol A.; Gaughan, John P.; Kulp, Heather; Dempsey, Daniel T.; Goldberg, Amy J.
April 2008
World Journal of Surgery;Apr2008, Vol. 32 Issue 4, p604
Academic Journal
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 (21.7% vs. 1.9%, p = 0.001), presented with field (95.7% vs. 72.6%, p = 0.016) and ED (87.0% vs. 60.5%, p = 0.014) SOLs, had sustainable cardiac rhythms (sinus tachycardia, 43.5% vs. 10.2%, p = 0.001; normal sinus rhythm, 17.4% vs. 4.5%, p = 0.037), and had measurable vital signs (65.2% vs. 25.5%; p = 0.001). However, only 3 of 23 (13.0%) survivors had all survival predictors, and one survivor had none. Frequent predictors in survivors were field SOLs (95.7%), ED SOLs (87.0%), salvageable initial cardiac rhythms (78.3%), and obtainable vital signs (65.2%). Stabbing mechanism (30.4%) and cardiac injury location (30.4%) 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.


Related Articles

  • Duration of life-threatening antecedents prior to intensive care admission. Hillman, Ken M.; Bristow, Peter J.; Chey, Tien; Daffurn, Kathy; Jacques, Theresa; Norman, Sandra L.; Bishop, Gillian F.; Simmons, Grant // Intensive Care Medicine;Nov2002, Vol. 28 Issue 11, p1629 

    Objective. To document the characteristics and incidence of serious abnormalities in patients prior to admission to intensive care units. Design and setting. Prospective follow-up study of all patients admitted to intensive care in three acute-care hospitals. Patients. The study population...

  • A Lost Son. Valdini, Anthony F. // Journal of Family Practice;Dec1996, Vol. 43 Issue 6, p525 

    The article focuses on the author's experience while saving a 14 year old boy who had been stabbed in the abdomen. Bloody clothes covered a transverse hole in his belly just above the navel. Omentum and a bit of intestine were poking out. During resuscitation, rescuers often talk to the victim,...

  • Traumatic Aortic Dissection In The Emergency Department: A Case Report. Karcioglu, �zg�r; Arslan, Engin Deniz; Parlak, Ismet; Korkmaz, Tanzer // Internet Journal of Rescue & Disaster Medicine;2002, Vol. 3 Issue 2, p2 

    Traumatic aortic dissection (TAD) is an uncommon but frequently emphasized entity in trauma management in the emergency department (ED). Sixty-eight year-old man was brought in the ED after being hit by a car. Examination disclosed diastolic murmur and multiple fractures. While the first unit of...

  • Performance of a Computerized Protocol for Trauma Shock Resuscitation. Sucher, Joseph F.; Moore, Frederick A.; Sailors, R. Matthew; Gonzalez, Ernest A.; McKinley, Bruce A. // World Journal of Surgery;Feb2010, Vol. 34 Issue 2, p216 

    A computerized protocol was developed and used to standardize bedside clinician decision making for resuscitation of shock due to severe trauma during the first day in the intensive care unit (ICU) at a metropolitan Level I trauma center. We report overall performance of a computerized protocol...

  • Advanced Trauma Life Support Study: Trauma Resuscitation Time. van Olden, Ger D. J.; Meeuwis, J. Dik; Bolhuis, Hugo W.; Boxma, Han; Goris, R. Jan A. // European Journal of Trauma;Dec2003, Vol. 29 Issue 6, p379 

    Background: The Advanced Trauma Life Support (ATLS®) course teaches procedures for administering initial trauma care. This study attempts to document changes that occurred in institutions after ATLS® training had been introduced. Patients and Methods: Prospective analysis by video-tape...

  • A Survey of Advanced Trauma Life-Support Training Amongst Doctors in Ireland. Moholkar Waterford, K. // Internet Journal of Emergency & Intensive Care Medicine;2005, Vol. 8 Issue 1, p17 

    The article presents information on a study, which aims to quantify the number of surgical trainees who were Advanced Trauma Life Support ( ATLS(r) ) trained in the Republic of Ireland and to assess waiting period to do a course, the effectiveness of the course and difficulties faced by the...

  • Intensive care management of head injury patients without routine intracranial pressure monitoring. Santhanam, R.; Pillai, Shibu V.; Kolluri, Sastry V. R.; Rao, U. M. // Neurology India;Oct-Dec2007, Vol. 55 Issue 4, p349 

    Background: Head injury contributes significantly to mortality and morbidity in India. Evaluation of the available trauma care facilities may help improve outcome. Aim: To evaluate the factors influencing the mortality of patients with head injury who had intensive care management and evolve...

  • Physician staffed helicopter emergency medical service dispatch via centralised control or directly by crew -- case identification rates and effect on the Sydney paediatric trauma system. Garner, Alan A.; Lee, Anna; Weatherall, Andrew // Scandinavian Journal of Trauma, Resuscitation & Emergency Medici;2012, Vol. 20 Issue 1, p1 

    Background: Severe paediatric trauma patients benefit from direct transport to dedicated Paediatric Trauma Centres (PTC). Parallel case identification systems utilising paramedics from a centralised dispatch centre versus the crew of a physician staffed Helicopter Emergency Medical Service...

  • Recording of vital signs in a district general hospital emergency department. Armstrong, B.; Walthall, H.; Clancy, M.; Mullee, M.; Simpson, H. // Emergency Medicine Journal;Dec2008, Vol. 25 Issue 12, p799 

    The article discusses findings of a study which examined factors that may influence the recording of vital signs in adult patients within the initial 15 minutes and after 60 minutes of arrival in the resuscitation and major areas of the emergency department. Several factors considered in the...


Read the Article


Sorry, but this item is not currently available from your library.

Try another library?
Sign out of this library

Other Topics