Resuscitative thoracotomy performed in the operating room

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Surgical Outcomes

Background:

• The effectiveness of resuscitative thoracotomy (RT) in trauma patients remains debated, with variable survival rates.
• Previous reviews indicate low survival rates for RT performed in the emergency department.

Purpose of the Study:

• To evaluate the hypothesis that higher survival rates are achieved with urgent/exigent thoracotomy in the operating room compared to emergency department RT.
• To compare survival outcomes between penetrating and blunt trauma patients undergoing different types of thoracotomy.

Main Methods:

• A retrospective review of injured patients undergoing urgent or exigent thoracotomy in the operating room between July 1983 and June 1989.
• Analysis of survival rates based on injury type (penetrating vs. blunt) and urgency of thoracotomy (resuscitative vs. urgent/non-resuscitative).

Main Results:

• Overall survival for exigent/resuscitative thoracotomy was 9% (3/34), with 37.5% (3/8) for penetrating injuries and 0% (0/26) for blunt trauma.
• Urgent/non-resuscitative thoracotomy had a significantly higher survival rate of 74% (40/54).
• Combined survival rates showed higher salvage for penetrating injuries (77%) versus blunt trauma (22%).

Conclusions:

• Resuscitative thoracotomy appears futile in blunt trauma patients in extremis.
• The high survival rates in penetrating injury patients support the continued use of RT when vital signs are lost, especially for thoracic injuries.
• Variability in reported survival rates may stem from patient mix (blunt vs. penetrating) and differing definitions of RT.