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October 1993

Predictors of Outcome in Patients Who Have Sustained Trauma and Who Undergo Emergency Thoracotomy

Author Affiliations

From the Womack Army Medical Center, Fort Bragg, NC, and the Uniformed Services University of the Health Sciences, Bethesda, Md (Dr Kavolius); and the Department of Trauma and Surgical Critical Care (Dr Golocovsky) and the Trauma Service, Department of Surgical Critical Care and Emergency Services (Dr Champion), Washington Hospital Center, Washington, DC.

Arch Surg. 1993;128(10):1158-1162. doi:10.1001/archsurg.1993.01420220078011

Objective:  To reassess the use of emergency thoracotomy in resuscitating victims of abdominal or thoracic trauma.

Design:  Retrospective review of records and autopsy reports of patients who underwent an emergency thoracotomy between 1983 and 1989.

Setting:  Washington Hospital Center's Level I trauma center.

Patients:  Two hundred eighty-four hemodynamically unstable trauma patients (212 [75%] with penetrating injuries and 72 [25%] with blunt injuries).

Intervention:  Emergency thoracotomy performed in the trauma operating room or in one of the trauma bays.

Main Outcome Measures and Key Findings:  In which subset of trauma patients is emergency thoracotomy a useful therapeutic modality? Performance of an emergency thoracotomy for blunt trauma resulted in an overall survival rate of 6% compared with 27% for penetrating trauma. The survival rate for patients with penetrating cardiac trauma was 32% (44% for stab wounds and 21% for gunshot wounds). Tamponade is a major factor associated with survival in this subset of patients and may act as a pathophysiologic filter.

Conclusions:  Emergency thoracotomy is a useful therapeutic modality for victims of penetrating trauma who have vital signs on admission to the hospital, and it should be considered in blunt trauma patients who present with any evidence of life. This modality is largely ineffective, however, in resuscitating victims of penetrating and blunt trauma who present to the hospital without vital signs.(Arch Surg. 1993;128:1158-1162)

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