Are there still selected applications for resuscitative thoracotomy in the emergency department after blunt trauma?

Resuscitative thoracotomy has an integral role for open cardiac massage and can be preformed after penetrating trauma with cardiovascular collapse. Its role in blunt trauma is questionable. We performed a retrospective chart review of patients who underwent an emergency department (ED) resuscitative thoracotomy. The goal was to define the role of resuscitative thoracotomy in blunt trauma at our institution. Forty-two patients underwent a resuscitative thoracotomy, 26 penetrating trauma (61.9%) and 16 blunt trauma (38.1%). Of these (n=16), there were 13 thoracic injuries (81.2%), eight cardiac injuries (50.0%), seven isolated abdominal injuries (43.7%) and 13 multiple (two or more locations) injuries (81.2%). Therapeutic interventions included pericardiotomy in 14 (87.5%), cardiac repair in three (18.7%), and pulmonary laceration repair in two (12.5%). All study patients had signs of life in the field; 13 maintained signs of life in transit (81.3%) and 12 upon admission to ED (75%). Average time from field to ED was 10.72 +/- 5.74 minutes. There were two survivors after blunt trauma (12.5%) and one after penetrating trauma (3.8%). Signs of life in the field and a cardiac repair were independent predictors of survival after blunt trauma (p=0.001 and p=0.004 respectively). We conclude that in select trauma patients after blunt injury with cardiovascular collapse, resuscitative thoracotomy still has a vital role.