Emergency Thoracotomy in a Swedish Setting: A Consecutive Series of 45 Patients from a Scandinavian Trauma Hospital

Abstract

Background: Emergency thoracotomy (ET) has previously been studied and evaluated in an American and African perspective. The mechanism of injury (MOI) varies between different parts of the world. In the Northern European setting, blunt trauma is the most common MOI. Regarding penetrating thoracic injuries stab wounds compromises the majority whereas gunshot wounds (GSW) are relatively scarce. The aim of this study was to describe the situation at a Scandinavian Trauma Hospital. Method:This study was a retrospective case series involving all patients who underwent an ET between 2004 and 2011 at a single centre. Patients were identified and data collection of demographics, trauma scores and physiological values were retrieved from hospital charts and trauma registry. Statistical analyses were performed.Results: A total of 45 ET patients were identified. The patients were predominately male (82%), and severely injured with median ISS of 48. The overall survival rate was 31%. Blunt trauma accounted for 60% of the patients. Survival following penetrating thoracic trauma had a 50% survival rate, whereas blunt trauma had a 19% survival rate. Conclusion:The injury pattern preceding ET is different between America and Europe. Blunt trauma accounts for the majority of cases. Penetrating trauma is mostly caused by stab wounds which carry a better prognosis than gunshot wounds (GSW). There is clearly a value in performing ET for selected cases following penetrating thoracic violence. Most of the surviving cases of thoracotomy for blunt trauma were for aortic cross clamping to control abdominal bleeding. Isolated blunt trauma to the chest carried a dismal prognosis.

Predictors of survival in trauma patients requiring resuscitative thoracotomy: A scoping review

“…2,3 Previous studies have identified overall poor outcomes following RT, particularly in the context of blunt injuries when compared to penetrating trauma. [4][5][6][7][8] Additionally, several factors have been linked to lower likelihoods of survival, including the performance of RT more than 30 min after hospital arrival, RT in the context of traumatic cardiac arrest (TCA), the patient's clinical status on emergency department (ED) arrival, RT procedure duration, heart rate (HR) at the end of the procedure, absence of signs of life (SOL) on-scene or in the ED, and cardiopulmonary resuscitation (CPR) duration. [9][10][11][12][13] However, to date, data have primarily focused on in-hospital and injury-specific variables and literature that synthesizes what we know about outcome predictors in the trauma population following RT is lacking.…”