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Retrospective analysis of emergency room thoracotomy in pediatric severe trauma patients

M Hofbauer1, M Hüpfl, M Figl

  • 1Department of Trauma Surgery, Medical University Vienna, Waehringer Guertel 18-20, A-1090 Vienna, Austria. marcus.hofbauer@meduniwien.ac.at

Resuscitation
|November 25, 2010
PubMed

Insights

Emergency thoracotomy in children with blunt trauma cardiac arrest is universally fatal. Survival depends on the injury mechanism and signs of life upon arrival, not the procedure itself.

Area of Science:

  • Pediatric Trauma Surgery
  • Emergency Medicine
  • Cardiothoracic Surgery

Background:

  • Emergency department (ED) thoracotomy for open cardiac massage is well-documented in adults but controversial in pediatric cases.
  • Limited data exists on the efficacy and outcomes of ED thoracotomy in children.

Purpose of the Study:

  • To evaluate the outcomes and prognostic factors of ED thoracotomy in pediatric patients.
  • To analyze the role of ED thoracotomy in pediatric cardiac arrest due to trauma.

Main Methods:

  • Retrospective cohort review of pediatric patients undergoing ED thoracotomy at a European Level I trauma center (1992-2008).
  • Analysis of clinical presentation, injury mechanisms, surgical interventions, and patient outcomes.
  • Inclusion of 11 pediatric patients (mean age 7.8 years) with blunt or penetrating trauma.

Main Results:

  • 91% of patients (10/11) undergoing ED thoracotomy died.
  • The majority of blunt trauma cases (91%) resulted in fatalities.
  • The sole survivor had a penetrating knife injury with stable vital signs on arrival.

Conclusions:

  • ED thoracotomy for pediatric cardiac arrest from blunt trauma is associated with a universally fatal outcome.
  • Injury mechanism and presence of vital signs at arrival are critical predictors of survival.
  • The procedure's utility in pediatric trauma cardiac arrest remains highly questionable, particularly for blunt injuries.
Abstract

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