Emergency thoracotomy: a review of its role in severe chest trauma

We aim to assess which group of patients with blunt or penetrating chest trauma will benefit from emergency thoracotomy (ET) and have a good functional outcome.

A literature search was conducted using PUBMED, EMBASE, Science Direct and Google Scholar. The search terms used were: emergency thoracotomy; penetrating chest injury; blunt chest injury. The inclusion criteria were human trials, studies and case series on emergency or emergency department thoracotomy in adults and all papers that compared outcomes between patients with penetrating and blunt chest injury. All meta analysis, case reports, thoracotomies in children and the pediatric population, thoracotomies that were not performed in an emergency setting and papers that did not include data on both penetrating and blunt injuries were excluded.

A total of 20 papers met the above criteria. More ETs were performed in patients with penetrating chest injury (PCI); range 3 to 670, mean 122 compared to blunt chest injury (BCI); range 5 to 319, mean of 51. Survival of the patients who underwent ET seemed to be higher in the PCI group; range 2.7% to 37.5%, mean 17.0% compared to BCI group; range 0.6% to 60%, mean of 4.6%. Mean Survival rate was higher (70.9%) for stab wounds compared to gunshot wounds (29.2%). The mean percentage of neurologically intact survivors among PCI survivors 86% (164) were higher compared to the BCI group 12% (8).

Patients most likely to benefit from ET are those with penetrating chest injury, signs of life at scene or on arrival in the ED or pericardial tamponade. Hospitals should develop specific guidelines for emergency thoracotomy for patients with penetrating trauma, pericardial tamponade and witnessed cardiac arrest, as they are most likely to benefit from ET with improved chances of survival and good neurological outcome.