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Emergency room thoracotomy: a single surgeon's thirteen-year experience
The American Surgeon
|January 29, 2000
Summary
Emergency room thoracotomy (ERT) has high mortality and morbidity. Survival depends on penetrating chest trauma and absence of cardiac arrest upon initial evaluation. Management changes improved outcomes over time.
Area of Science:
- Trauma Surgery
- Emergency Medicine
- Thoracic Surgery
Background:
- Emergency room thoracotomy (ERT) is a critical intervention for specific life-threatening thoracic injuries.
- Outcomes and predictors of survival following ERT remain areas of significant clinical interest.
Purpose of the Study:
- To analyze postoperative complications and survival rates associated with ERT.
- To identify patient-specific factors (anatomic and physiologic) predictive of survival.
- To document the evolution of ERT management strategies over a 13-year period.
Main Methods:
- Retrospective review of a single surgeon's experience with 102 patients undergoing ERT over 13 years.
- Data analysis included mechanism of injury, survival to ICU and discharge, and postoperative complications.
- Comparison of survival rates between early and later periods of the study to assess impact of management changes.
Main Results:
- Overall survival to discharge was low (7/102), with higher rates in the later study period (15% vs. 1.6%).
- Penetrating chest injuries and absence of pre-hospital cardiac arrest were crucial for survival.
- Major complications were frequent among survivors (57%).
Conclusions:
- Postoperative complications and mortality following ERT are significant.
- Survival is strongly associated with penetrating injuries and initial hemodynamic stability.
- Evolving management strategies, including targeted interventions and withholding ERT in futile cases, improved survival rates.