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"Directed" emergency room thoracotomy: a prognostic prerequisite for survival
R R Ivatury1, J Kazigo, M Rohman
1Department of Surgery, New York Medical College, Bronx.
The Journal of Trauma
|August 1, 1991
Summary
Emergency room thoracotomy (ERT) shows survival benefits primarily in penetrating thoracic trauma, especially when directed at cardiac injury. ERT is not beneficial for blunt trauma patients.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Critical Care
Background:
- Resuscitative thoracotomy in the emergency room (ERT) is a life-saving procedure for specific trauma patients.
- Indications for ERT require reassessment based on current outcomes.
Purpose of the Study:
- To reassess the indications for emergency room thoracotomy (ERT).
- To evaluate the prognostic significance of ERT in different trauma scenarios.
Main Methods:
- Retrospective review of 163 patients undergoing ERT.
- Analysis of patient demographics, injury types (stab wounds, gunshot wounds, blunt trauma), injury locations, and outcomes.
- Stratification of outcomes based on Revised Trauma Score (RTS) and ERT direction.
Main Results:
- Overall survival rate was 9.8% (16 of 163 patients).
- No survival was observed in blunt trauma patients.
- Survival was highest (21.4%) in patients with thoracic penetration and directed ERT for potential cardiac injury.
- ERT was beneficial in restoring cardiac rhythm in extremity vascular injuries (40% survival).
Conclusions:
- ERT directed at potential cardiac injury in penetrating thoracic trauma is a crucial prognostic factor for survival, particularly in patients without vital signs on arrival.
- ERT is not indicated for blunt trauma.
- The efficacy of ERT for penetrating abdominal injuries remains unproven.