Emergency department thoracotomy following injury: Critical determinants for patient salvage

Abstract

Abstract The role of emergency department (ED) thoracotomy in resuscitation of the moribund trauma patient remains ill‐defined. The purpose of this article is to analyze our experience during the past decade in order to elucidate prognostic features enabling a more cost‐effective application of this heroic measure . Injury mechanism in the 632 ED thoracotomies performed in our trauma consortium consisted of blunt (BLT) in 50%, gunshot wounds (GSW) in 35%, and stab wounds (SW) in 15%. Mean patient age was 31 years, and 76% were men. Twenty‐nine (5%) of the patients were ultimately discharged alive from the hospital. Outcome was analyzed on the basis of physiologic status at presentation to the ED: group I, n=481 (76%), presented without signs of life (SL); group II, n=38 (6%), presented with SL (pupillary response), but without vital signs (VS); and group III, n=113 (18%), presented with VS. Survival without SL was 10% of SW, 1% of GSW, and 1% of BLT. When VS were present, patient salvage was 32% following SW, 15% following GSW, and 5% after blunt trauma. Five of 15 survivors without SL had irreversible cerebral damage; whereas, 13 of the 14 survivors with VS had no permanent neurologic sequelae . This experience underscores the rationale for selective application of ED thoracotomy done for postinjury resuscitation; functional salvage of the blunt trauma victim arriving lifeless is nil while nearly one‐third of patients in extremis from a thoracic SW can be returned to their preinjury state .