Survival following resuscitative thoracotomy for combined left ventricle and left atrium ruptures secondary to blunt trauma

Fitzgerald, Mark; Basu, Abhishek; Rahman, Fatima; Russell, T.; Hines, Jane; Gooi, Julian; Marasco, Silvana; Bezer, Lamia; Effeney, Peter; Bunbury, K. M.

doi:10.1016/j.injury.2008.04.024

Cited by 4 publications

(5 citation statements)

References 16 publications

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“…All patients who underwent RT at the Alfred Hospital from 1 July 2009 to 30 June 2017 were identified from the Alfred Health Trauma Registry. 5,9 The Alfred Research and Ethics Committee approved the present study.…”

Section: Setting and Patientsmentioning

confidence: 99%

“…3,4 The use of focused assessment with sonography in trauma (FAST) can establish the diagnosis of haemopericardium which may trigger urgent pericardial decompression through resuscitative thoracotomy (RT) for haemodynamically unstable patients. 5 In 2010, the authors proposed that RT for trauma be primarily reserved for patients with cardiac tamponade on ultrasound and with deteriorating haemodynamics requiring immediate intervention or those already undergoing cardiopulmonary resuscitation with cardiac activity on ultrasound. 4 This indication was in contrast to practice in other centres with a study from the USA reporting that tamponade with cardiac activity was variably observed, with almost half the patients having RT performed after loss of vital signs and in the absence of cardiac motion or pericardial fluid.…”

Section: Introductionmentioning

confidence: 99%

See 1 more Smart Citation

Emergency department resuscitative thoracotomy at an adult major trauma centre: Outcomes following a training programme with standardised indications

Fitzgerald

Yong

Martin

et al. 2020

Emerg Medicine Australasia

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ObjectiveThe objective of this study was to report the procedural incidence and patient outcomes after the 2009 introduction of an institutional resuscitative thoracotomy (RT) programme. Emergency physicians, general surgeons and emergency nursing trauma team members were trained to perform RT on thoracic trauma patients with an unresponsive systolic blood pressure (SBP) <70 mmHg within 30 min of arrival, prior to cardiothoracic team back‐up.MethodsA retrospective cohort study was conducted on patients who underwent RT from 2009 to 2017. The primary outcome measures were the incidence of the procedure and patients' survival to hospital discharge. Variables associated with survival were assessed using univariable logistic regression analyses.ResultsThere were 12 399 major trauma patients, including 7657 with major thoracic trauma and 315 presenting with SBP <70 mmHg. There were 32 RTs performed (incidence of 0.4%; 95% confidence interval [CI] 0.3–0.6) among patients with major thoracic trauma and 10.2% (99% CI 7.3–13.4) among patients with major thoracic trauma and SBP <70 mmHg. There were eight (25%; 95% CI 13.2–42.1) survivors to hospital discharge and no late mortality (mean follow‐up 2.8 years). Survival was significantly associated with the procedure performed within 30 min of arrival (odds ratio 0.09; 95% CI 0.01–0.67) while mortality was associated with the procedure being performed in the setting of traumatic cardiac arrest (odds ratio 18.3; 95% CI 2.4–140.4).ConclusionsA formal training and credentialing programme was associated with a low incidence of the procedure, yet achieved a survival rate of 25%, which is comparable to other reported literature.

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Section: Setting and Patientsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Emergency department resuscitative thoracotomy at an adult major trauma centre: Outcomes following a training programme with standardised indications

Fitzgerald

Yong

Martin

et al. 2020

Emerg Medicine Australasia

View full text Add to dashboard Cite

show abstract

“…Successful operative management has since been described in all these situations (Kato et al, 1994;Weiner et al, 1996;Grande et al, 2003;Lu et al, 2005;Namai et al, 2007;Fitzgerald et al, 2008;Seguin et al, 2008). A recent case report by Fitzgerald et al (2008) described successful repair of combined left ventricular and atrial rupture in association with significant extracardiac injuries including: multiple rib fractures and pulmonary contusions, an unstable cervical fracture, a liver laceration, renal contusion and a splenic laceration requiring splenectomy.…”

Section: Operative Managementmentioning

confidence: 99%

Cardiac rupture following blunt trauma

Berg

Talving

Inaba

2010

Trauma

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Cardiac rupture is the most extreme manifestation of blunt cardiac injury. In the first half of the 20th century this lesion was uniformly fatal. Since the first successful post-traumatic cardiorrhaphy by Desforges in 1955, multiple case reports and retrospective reviews have documented successful operative repair and survival of patients with this injury. Despite these successes, blunt cardiac rupture remains associated with a high mortality rate. The rarity of this condition and the heterogeneity of the literature make determination of exact epidemiologic data difficult. The classic clinical presentation is not universal and a subset of patients may present asymptomatically. Rapid transportation to medical care, accurate timely diagnosis and emergent operative intervention are essential for successful outcome. The use of ultrasonography in the trauma bay is a key component of early identification of these injuries. Specific outcome factors associated with survival are difficult to determine and even in those who survive to medical attention mortality rates remain as high as 60—90%.

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“…In recent years the widespread availability and use of ultrasound for the initial assessment of severely injured patients has facilitated the early diagnosis of cardiac tamponade and associated cardiac injuries. Resuscitative thoracotomy is a life‐saving intervention for haemodynamically unstable patients in extremis and with proven cardiac tamponade on ultrasound 1,2 …”

Section: Introductionmentioning

confidence: 99%

“…Resuscitative thoracotomy is a life-saving intervention for haemodynamically unstable patients in extremis and with proven cardiac tamponade on ultrasound. 1,2…”

Section: Introductionmentioning

confidence: 99%