Emergency Thoracotomy – The Indications, Contraindications and Evidence

Rn, Penny S. Morgan, Bs, Aa,; Garner, Jeff

doi:10.1136/jramc-155-02-02

Cited by 20 publications

(10 citation statements)

References 53 publications

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“…Altogether, loss of SOL as an indication for an immediate thoracotomy deserves extra observation in the future, focusing in particular on low-incidence regions. Concomitant abdominal injury was found to be more prominent among the patients who died, which is in agreement with several studies from high-incidence regions [5, 6, 37, 38]. Mortality rates in our study were higher in patients receiving both a thoracotomy and a laparotomy.…”

Section: Discussionsupporting

confidence: 92%

Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center

Waes

Riet

Lieshout

et al. 2012

Eur J Trauma Emerg Surg

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Background An emergency department thoracotomy (EDT) or an emergency thoracotomy (ET) in the operating theater are both beneficial in selected patients following thoracic penetrating injuries. Since outcome-descriptive European studies are lacking, the aim of this retrospective study was to evaluate ten years of experience at a Dutch level I trauma center. Method Data on patients who underwent an immediate thoracotomy after sustaining a penetrating thoracic injury between October 2000 and January 2011 were collected from the trauma registry and hospital files. Descriptive and univariate analyses were performed. Results Among 56 patients, 12 underwent an EDT and 44 an ET. Forty-six patients sustained one or multiple stab wounds, versus ten with one or multiple gunshot wounds. Patients who had undergone an EDT had a lower GCS ( p < 0.001), lower pre-hospital RTS and hospital triage RTS ( p < 0.001 and p = 0.009, respectively), and a lower SBP ( p = 0.038). A witnessed loss of signs of life generally occurred in EDT patients and was accompanied by 100 % mortality. Survival following EDT was 25 %, which was significantly lower than in the ET group (75 %; p = 0.002). Survivors had lower ISS ( p = 0.011), lower rates of pre-hospital ( p = 0.031) and hospital ( p = 0.003) hemodynamic instability, and a lower prevalence of concomitant abdominal injury ( p = 0.002). Conclusion The overall survival rate in our study was 64 %. The outcome of immediate thoracotomy performed in this level I trauma center was similar to those obtained in high-incidence regions like the US and South Africa. This suggests that trauma units where immediate thoracotomies are not part of the daily routine can achieve similar results, if properly trained.

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Section: Discussionsupporting

confidence: 92%

Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center

Waes

Riet

Lieshout

et al. 2012

Eur J Trauma Emerg Surg

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“…This technique is performed most commonly via a thoracotomy with aortic crossclamp; however, this technique requires advanced resources and yields few survivors. [7][8][9] Recognition of these limitations has motivated investigators to explore other methods of achieving aortic occlusion earlier and by less invasive means. [10][11][12] One such alternative is endovascular balloon occlusion, which is practiced by vascular surgeons to control the inflow of an abdominal aortic aneurysm during the placement of a stent graft.…”

mentioning

confidence: 99%

Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock

Markov

Percival

Morrison

et al. 2013

Surgery

161

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“…Access to the heart and OC-CPR must be achieved within a minutes. While several incisions have been used for performing resuscitative thoracotomies, the left anterior thoracotomy (LAT) is typically considered the standard method as it provides rapid access to the heart and descending aorta [ 31 ]. The bilateral anterior thoracotomy (Clamshell) has been demonstrated to provide better access to thoracic structures in thoracic trauma but for the purposes of OC-CPR in non-traumatic cardiac arrest the LAT could suffice [ 32 ].…”

Section: Discussionmentioning

confidence: 99%

Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest

Kornhall

Dolven

2014

World J Emerg Surg

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Since the popularisation of closed chest cardiac compressions in the 1960s, open chest compressions in non-traumatic cardiac arrest have become a largely forgotten art. Today, open chest compressions are only rarely performed outside operating theatres. Early defibrillation and high quality closed chest compressions is the dominating gold standard for the layman on the street as well as for the resuscitation specialist. In this paper we argue that the concept of open chest direct cardiac compressions in non-traumatic cardiac arrest should be revisited and that it might be due for a revival. Numerous studies demonstrate how open chest cardiac compressions are superior to closed chest compressions in regards to physiological parameters and outcomes. Thus, by incorporating resuscitative thoracotomies and open chest compressions in our algorithms for non-traumatic cardiac arrest we may improve outcomes.

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Emergency Thoracotomy – The Indications, Contraindications and Evidence

Cited by 20 publications

References 53 publications

Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center

Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center

Physiologic tolerance of descending thoracic aortic balloon occlusion in a swine model of hemorrhagic shock

Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest

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