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Kumar A, Shiwalkar N, Bhate S, Keshavamurthy S. Management of Thoracic and Cardiac Trauma: A Case Series and Literature Review. Cureus 2022; 14:e26465. [PMID: 35800197 PMCID: PMC9246353 DOI: 10.7759/cureus.26465] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 06/24/2022] [Indexed: 11/05/2022] Open
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Haida VM, Yamashita EM, Franco GS, Amado WBR, Arakaki IK, Dal-Bosco CLB, Zwierzikowski JA, Collaço IA, Cavassin GP. Performance and outcome of ressucitative thoracotomies in a southern Brazil trauma center: a 7-year retrospective analysis. Rev Col Bras Cir 2022; 49:e20223146. [PMID: 35319564 PMCID: PMC10578860 DOI: 10.1590/0100-6991e-20223146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/04/2021] [Accepted: 10/06/2021] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE the study aims to analyze the performance and outcome of resuscitation thoracotomy (TR) performed in patients victims of penetrating and blunt trauma in a trauma center in southern Brazil during a 7 years period. METHODS retrospective study based on the analysis of medical records of patients undergoing TR, from 2014 to 2020, in the emergency service of the Hospital do Trabalhador, Curitiba - Paraná, Brazil. RESULTS a total of 46 TR were performed during the study period, of which 89.1% were male. The mean age of patients undergoing TR was 34.1±12.94 years (range 16 and 69 years). Penetrating trauma corresponded to the majority of indications with 80.4%, of these 86.5% victims of gunshot wounds and 13.5% victims of knife wounds. On the other hand, only 19.6% undergoing TR were victims of blunt trauma. Regarding the outcome variables, 84.78% of the patients had declared deaths during the procedure, considered non-responders. 15.22% of patients survived after the procedure. 4.35% of patients undergoing TR were discharged from the hospital, 50% of which were victims of blunt trauma. CONCLUSION the data obtained in our study are in accordance with the world literature, reinforcing the need for a continuous effort to perform TR, respecting its indications and limitations in patients victims of severe penetrating or blunt trauma.
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Affiliation(s)
- Vitor Mamoru Haida
- - Universidade Positivo, Departamento de Medicina - Curitiba - PR - Brasil
- - Hospital do Trabalhador, Departamento de Cirurgia Geral - Curitiba - PR - Brasil
| | | | | | | | | | | | | | - Iwan Augusto Collaço
- - Hospital do Trabalhador, Departamento de Cirurgia Geral - Curitiba - PR - Brasil
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Teeratakulpisarn P, Angkasith P, Tanmit P, Thanapaisal C, Prasertcharoensuk S, Wongkonkitsin N. A Life Saving Emergency Department Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) with Open Groin Technique. Open Access Emerg Med 2021; 13:183-188. [PMID: 34040460 PMCID: PMC8140941 DOI: 10.2147/oaem.s311421] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/16/2021] [Accepted: 04/28/2021] [Indexed: 11/29/2022] Open
Abstract
A 53-year-old male pedestrian was hit by a car and arrived at our hospital with a blunt abdominal injury and hemorrhagic shock. Resuscitative Endovascular Balloon Occlusion of the Aorta (REBOA) was performed in a timely fashion using the open groin technique in the emergency room. The procedure resulted in rapid improvement of hemodynamic status while the bleeding source was controlled. Recently, REBOA is a proper adjunctive procedure in major non-compressible torso hemorrhage patients. The procedure requires a portable X-ray or fluoroscopic machine in the ER to confirm the balloon’s position. This method has likely limited the use of REBOA in developing countries. The procedure with open groin technique, using anatomical landmarks and physiologic change to confirm the position of the balloon, has been developed to address these concerns. Here we report on the treatment’s success with this technique and believe that it can benefit trauma patient care.
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Affiliation(s)
- Panu Teeratakulpisarn
- Department of Surgery, Faculty of Medicine, Khonkaen University, Khon Kaen, Thailand
| | - Phati Angkasith
- Department of Surgery, Faculty of Medicine, Khonkaen University, Khon Kaen, Thailand
| | - Parichat Tanmit
- Department of Surgery, Faculty of Medicine, Khonkaen University, Khon Kaen, Thailand
| | - Chaiyut Thanapaisal
- Department of Surgery, Faculty of Medicine, Khonkaen University, Khon Kaen, Thailand
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Topjian AA, Raymond TT, Atkins D, Chan M, Duff JP, Joyner BL, Lasa JJ, Lavonas EJ, Levy A, Mahgoub M, Meckler GD, Roberts KE, Sutton RM, Schexnayder SM. Part 4: Pediatric Basic and Advanced Life Support: 2020 American Heart Association Guidelines for Cardiopulmonary Resuscitation and Emergency Cardiovascular Care. Circulation 2020; 142:S469-S523. [PMID: 33081526 DOI: 10.1161/cir.0000000000000901] [Citation(s) in RCA: 197] [Impact Index Per Article: 49.3] [Reference Citation Analysis] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
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Aseni P, Rizzetto F, Grande AM, Bini R, Sammartano F, Vezzulli F, Vertemati M. Emergency Department Resuscitative Thoracotomy: Indications, surgical procedure and outcome. A narrative review. Am J Surg 2020; 221:1082-1092. [PMID: 33032791 DOI: 10.1016/j.amjsurg.2020.09.038] [Citation(s) in RCA: 19] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/19/2020] [Revised: 08/29/2020] [Accepted: 09/28/2020] [Indexed: 11/19/2022]
Abstract
BACKGROUND Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient's outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries. METHODS Literature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints. RESULTS A total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT. CONCLUSIONS EDRT should be reserved for acute resuscitation of selected dying trauma patient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure.
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Affiliation(s)
- Paolo Aseni
- Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy.
| | - Francesco Rizzetto
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy; Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy.
| | - Antonino M Grande
- Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo Pavia, viale Camillo Golgi 19, 27100, Pavia, Italy.
| | - Roberto Bini
- Trauma Center and Metropolitan Trauma Network Department, Niguarda Hospital, Milan, Italy.
| | - Fabrizio Sammartano
- Trauma Center and Metropolitan Trauma Network Department, Niguarda Hospital, Milan, Italy.
| | - Federico Vezzulli
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy.
| | - Maurizio Vertemati
- Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy; CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), Università degli Studi di Milano, Milan, Italy.
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Schimrigk J, Baulig C, Buschmann C, Ehlers J, Kleber C, Knippschild S, Leidel BA, Malysch T, Steinhausen E, Dahmen J. [Indications, procedure and outcome of prehospital emergency resuscitative thoracotomy-a systematic literature search]. Unfallchirurg 2020; 123:711-723. [PMID: 32140814 DOI: 10.1007/s00113-020-00777-8] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Prehospital resuscitative thoracotomy (PHRT) is a controversially discussed measure for the acute treatment of traumatic cardiac arrest (TCA) recommended by the current guidelines of the European Resuscitation Council (ERC). The aim of this work is the comprehensive presentation and summary of the available literature with the underlying hypothesis that the available publications show the feasibility and survival following PHRT in patients with TCA with a good neurological outcome. METHOD A systematic literature search was performed in the databases PubMed, EMBASE, Google Scholar, Springer LINK and Cochrane. The study selection, data extraction and evaluation of bias potential were performed independently by two authors. The outcome of patients with TCA after PHRT was selected as the primary endpoint. RESULTS A total of 4616 publications were found of which 21 publications with a total of 287 patients could be included in the analyses. For a detailed descriptive analysis, 15 publications with a total of 205 patients were suitable. The TCA of these patients was most commonly caused by pericardial tamponade, thoracic vascular injuries and severe extrathoracic multiple injuries. In 24% of the cases TCA occurred in the presence of the emergency physician. Clamshell thoracotomy (53%) was used preclinically more often than anterolateral thoracotomy (47%). Of the PHRT patients after TCA 12% (25/205) left the hospital alive, 9% (n = 19/205) with good neurological outcome and 1% (n = 3/205) with poor neurological outcome (according to the Glasgow outcome scale, GOS). CONCLUSION The prognosis of TCA seems to be much better than has long been assumed. Decisive for the success of resuscitation efforts in TCA seems to be the immediate, partly invasive treatment of all reversible causes. The measures for TCA recommended by the ERC resuscitation guidelines, seem to be poorly implemented, especially in the preclinical setting. A controversy regarding the recommendations of the guidelines is the question of whether a PHRT can be successfully implemented and if the comprehensive introduction in Germany seems to be meaningful. Despite the recommendation of the guidelines, this systematic review and meta-analysis underlines the lack of high-quality evidence on PHRT, whereby a survival probability to hospital discharge of 12% was reported, of which 75% had a good neurological outcome. The risk of bias of the results in individual publications as well as in this review is high. Further systematic research in the field of preclinical trauma resuscitation is particularly necessary also for acceptance of the guidelines.
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Affiliation(s)
- J Schimrigk
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Baulig
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Buschmann
- Institut für Rechtsmedizin, Charité - Universitätsmedizin Berlin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin and Berlin Institute of Health, Berlin, Deutschland
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
| | - J Ehlers
- Lehrstuhl für Didaktik und Bildungsforschung im Gesundheitswesen, Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - C Kleber
- AG Trauma, Deutscher Rat für Wiederbelebung - German Resuscitation Council (GRC), Ulm, Deutschland
- Chirurgische Notaufnahme, Universitätszentrum für Orthopädie & Unfallchirurgie, Universitätsklinikum TU Dresden, Dresden, Deutschland
| | - S Knippschild
- Institut für Medizinische Biometrie und Epidemiologie (IMBE), Department Humanmedizin, Fakultät für Gesundheit, Universität Witten/Herdecke, Witten/Herdecke, Deutschland
| | - B A Leidel
- Zentrale Notaufnahme, Campus Benjamin Franklin, Charité - Universitätsmedizin Berlin, Berlin, Deutschland
| | - T Malysch
- Klinik für Anästhesiologie und Intensivtherapie, Klinikum Brandenburg, Medizinische Hochschule Brandenburg, Brandenburg, Deutschland
| | - E Steinhausen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland
| | - J Dahmen
- Klinik für Orthopädie und Unfallchirurgie, BG Klinikum Duisburg, Duisburg, Deutschland.
- Ärztliche Leitung Rettungsdienst Berlin, Fakultät für Gesundheit, Department Humanmedizin, Universität Witten/Herdecke, Alfred-Herrhausen-Straße 50, 58455, Witten, Deutschland.
- Ärztliche Leitung Rettungsdienst, Berliner Feuerwehr, Voltairestraße 2, 10179, Berlin, Deutschland.
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Thorsen K, Vetrhus M, Narvestad JK, Reite A, Larsen JW, Vennesland J, Tjosevik KE, Søreide K. Performance and outcome evaluation of emergency resuscitative thoracotomy in a Norwegian trauma centre: a population-based consecutive series with survival benefits. Injury 2020; 51:1956-1960. [PMID: 32522355 DOI: 10.1016/j.injury.2020.05.040] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/12/2020] [Revised: 05/08/2020] [Accepted: 05/23/2020] [Indexed: 02/02/2023]
Abstract
BACKGROUND Emergency resuscitative thoracotomy (ERT) is a lifesaving procedure for select indications in severely injured patients. The main body of the literature stem from regions with a high prevalence of penetrating injuries, while data from European institutions remain scarce. We aimed to evaluate a decade of ERT in a Norwegian trauma centre. METHODS A prospectively collected series from the institutional trauma registry of all consecutive trauma patients who had an ERT at Stavanger University Hospital (SUH) from 2006 to 2018. Data were extracted using both registry and electronic patient record (EPR) data, including injury profile, demographics and outcomes. Comparison of groups were done by descriptive statistics. RESULTS A total of 26 ERTs were performed during the study period, of which 20 were men (75%) and 6 women (25%). Five patients (19%) survived to hospital discharge, of which 3 men and 2 women with a median age of 46 years (range 24-68). All survivors had thoracic injury as location of major injury (LOMI.). Of the five survivors, four suffered blunt injury and one patient penetrating injury. At one-year of follow-up of the survivors, three patients scored 8/8 on Glasgow outcome scale-extended, 1 patient scored 7/8 and one patient 5/8. CONCLUSION In this study, ERT conferred good outcome with survival in one of every five procedures. Performing ERT in severely injured patients presenting in extremis appears to be justified even in low-volume centres and in blunt trauma.
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Affiliation(s)
- K Thorsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway.
| | - M Vetrhus
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Science, University of Bergen, Bergen, Norway
| | - J K Narvestad
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - A Reite
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway
| | - J Wiik Larsen
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
| | - J Vennesland
- Department of Vascular Surgery, Stavanger University Hospital, Stavanger, Norway
| | - K E Tjosevik
- Department of Emergency Medicine, Stavanger University Hospital, Stavanger, Norway
| | - K Søreide
- Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway; Department of Clinical Medicine, University of Bergen, Bergen, Norway
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Endo A, Kojima M, Hong ZJ, Otomo Y, Coimbra R. Open-chest versus closed-chest cardiopulmonary resuscitation in trauma patients with signs of life upon hospital arrival: a retrospective multicenter study. CRITICAL CARE : THE OFFICIAL JOURNAL OF THE CRITICAL CARE FORUM 2020; 24:541. [PMID: 32873326 PMCID: PMC7465718 DOI: 10.1186/s13054-020-03259-w] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/22/2020] [Accepted: 08/23/2020] [Indexed: 11/15/2022]
Abstract
Background The effectiveness and indications of open-chest cardiopulmonary resuscitation (OCCPR) have been still debatable. Although current guidelines state that the presence of signs of life (SOL) is an indication for OCCPR, scientific evidence corroborating this recommendation has been scarce. This study aimed to compare the effectiveness of OCCPR to closed-chest cardiopulmonary resuscitation (CCCPR) in severe trauma patients with SOL upon arrival at the emergency department (ED). Methods A retrospective cohort study analyzing data from the Trauma Quality Improvement Program (TQIP) database, a nationwide trauma registry in the USA, between 2010 and 2016 was conducted. Severe trauma patients who had SOL upon arrival at the hospital and received cardiopulmonary resuscitation within the first 6 h of ED admission were identified. Survival to hospital discharge was evaluated using logistic regression analysis, instrumental variable analysis, and propensity score matching analysis adjusting for potential confounders. Results A total of 2682 patients (OCCPR 1032; CCCPR 1650) were evaluated; of those 157 patients (15.2%) in the OCCPR group and 193 patients (11.7%) in the CCCPR group survived. OCCPR was significantly associated with higher survival to hospital discharge in both the logistic regression analysis (adjusted odds ratio [95% confidence interval] = 1.99 [1.42–2.79], p < 0.001) and the instrumental variable analysis (adjusted odds ratio [95% confidence interval] = 1.16 [1.02–1.31], p = 0.021). In the propensity score matching analysis, 531 matched pairs were generated, and the OCCPR group still showed significantly higher survival at hospital discharge (89 patients [16.8%] in the OCCPR group vs 58 patients [10.9%] in the CCCPR group; odds ratio [95% confidence interval] = 1.66 [1.13–2.42], p = 0.009). Conclusions Compared to CCCPR, OCCPR was associated with significantly higher survival at hospital discharge in severe trauma patients with SOL upon ED arrival. Further studies to confirm these results and to assess long-term neurologic outcomes are needed.
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Affiliation(s)
- Akira Endo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Mitsuaki Kojima
- Emergency and Critical Care Medicine, Tokyo Women's Medical University Medical Center East, 2-1-10 Nishiogu, Arakawa-ku, Tokyo, Japan
| | - Zhi-Jie Hong
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.,Division of Traumatology, Department of Surgery, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan, Republic of China
| | - Yasuhiro Otomo
- Trauma and Acute Critical Care Center, Tokyo Medical and Dental University Hospital of Medicine, 1-5-45 Yushima, Bunkyo-ku, Tokyo, Japan
| | - Raul Coimbra
- Riverside University Health System, Comparative Effectiveness and Clinical Outcomes Research Center, 26520 Cactus Avenue, CPC Suite 102-5, Moreno Valley, CA, 92555, USA.
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Kelly GS, Clare D. Improving out-of-hospital notification in traumatic cardiac arrests with novel usage of smartphone application. J Am Coll Emerg Physicians Open 2020; 1:618-623. [PMID: 33000080 PMCID: PMC7493493 DOI: 10.1002/emp2.12146] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Revised: 05/13/2020] [Accepted: 05/18/2020] [Indexed: 11/07/2022] Open
Abstract
INTRODUCTION Timely out-of-hospital notifications in patients with traumatic cardiac arrest are associated improvements in mortality. Details surrounding these events are often limited, and decisions to perform advanced resuscitative procedures must be made based on limited data. This study evaluated the ability of a mobile application (app) called Citizen (sp0n Inc., New York, NY) to address these issues by providing a novel, secondary source of out-of-hospital information in traumatic cardiac arrest. Citizen sends notifications to mobile devices in response to nearby detected public safety events, and we sought to evaluate its utility in prenotification for traumatic cardiac arrest. METHODS This was a retrospective observational study. Patients ≥ 15 years of age with traumatic cardiac arrest attributed to penetrating trauma were included. The 2 coprimary outcomes observed were the time difference between the app notification and emergency medical services notification, and the app's success rate in generating a notification for each patient in traumatic cardiac arrest. RESULTS From February 2, 2019 to October 10, 2019, there were 43 patients who met the criteria for this study. On average, the Citizen app notification arrived 12.9 minutes before emergency medical services radio notification (95% confidence interval, 9.2-16.6; P < 0.001). Citizen generated a notification for 36 of 43 patients (84%). CONCLUSION The Citizen app generates earlier notifications in traumatic cardiac arrest compared with standard radio communications. It also provides a previously unavailable secondary source of information for making rapid resuscitative decisions upon the arrival of the arresting patient to the emergency department. Further research is needed to determine how to optimally integrate the app into existing trauma systems.
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Affiliation(s)
- Geoffrey S. Kelly
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Drew Clare
- Department of Emergency MedicineJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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Transcatheter closure of a chronic post-traumatic aorto-right ventricular fistula. PROGRESS IN PEDIATRIC CARDIOLOGY 2020. [DOI: 10.1016/j.ppedcard.2020.101196] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/21/2022]
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Segalini E, Di Donato L, Birindelli A, Piccinini A, Casati A, Coniglio C, Di Saverio S, Tugnoli G. Outcomes and indications for emergency thoracotomy after adoption of a more liberal policy in a western European level 1 trauma centre: 8-year experience. Updates Surg 2018; 71:121-127. [PMID: 30588565 PMCID: PMC6450838 DOI: 10.1007/s13304-018-0607-4] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2018] [Accepted: 11/11/2018] [Indexed: 12/03/2022]
Abstract
The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome. 27 ETs were performed: 21 after blunt trauma and 6 after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40.5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long-term neurological sequelae were reported. The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centres have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient’s survival; the possibility of organ donation should be taken into consideration as well.
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Affiliation(s)
- Edoardo Segalini
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Luca Di Donato
- General and Emergency Surgery, Arcispedale S. Maria Nuova Hospital, Reggio Emilia, Italy
| | - Arianna Birindelli
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Alice Piccinini
- Division of Trauma and Surgical Critical Care, LAC + USC Medical Center, University of Southern California, Los Angeles, CA, USA
| | - Alberto Casati
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Carlo Coniglio
- Trauma Intensive Care Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
| | - Salomone Di Saverio
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy.
- Cambridge Colorectal Unit, Cambridge University Hospitals NHS Foundation Trust, Addenbrooke's Hospital, Cambridge Biomedical Campus, Hills Road, Cambridge, CB2 0QQ, UK.
| | - Gregorio Tugnoli
- Trauma Surgery Unit, Maggiore Hospital Regional Emergency Surgery and Trauma Center, Bologna Local Health District, Bologna, Italy
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