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The pediatric resuscitative thoracotomy during combat operations in Iraq and Afghanistan - A retrospective cohort

Steven G Schauer1, Guyon J Hill2, Richard E Connor3

  • 1US Army Institute of Surgical Research, JBSA, San Antonio, TX, United States; San Antonio Military Medical Center, JBSA, San Antonio, TX, United States; 59th Medical Wing, JBSA Lackland, TX, United States.

Injury
|February 8, 2018
PubMed

Insights

Pediatric resuscitative thoracotomy in combat zones showed a trend toward increased survival to discharge compared to CPR alone. Further research is needed to confirm benefits for children in austere environments.

Area of Science:

  • Trauma Surgery
  • Pediatric Critical Care
  • Military Medicine

Background:

  • Combat zone trauma presents unique challenges and injury patterns distinct from civilian settings.
  • The efficacy of pediatric resuscitative thoracotomy in deployed environments is not well-established due to limited data.
  • This study compares outcomes of pediatric patients in traumatic arrest receiving resuscitative thoracotomy versus cardiopulmonary resuscitation (CPR) alone.

Purpose of the Study:

  • To evaluate the effectiveness of resuscitative thoracotomy in pediatric patients experiencing traumatic arrest in combat zones.
  • To compare survival rates between pediatric patients undergoing resuscitative thoracotomy and those receiving CPR only.
  • To identify potential benefits and areas for improvement in pediatric trauma care in austere military settings.

Main Methods:

  • Data were extracted from the Department of Defense Trauma Registry (DODTR) between 2007 and 2016.
  • Pediatric subjects (under 18) in Iraq or Afghanistan undergoing prehospital or emergency department resuscitative thoracotomy or CPR were identified.
  • CPR cases were matched to thoracotomy cases based on injury mechanisms to ensure comparable cohorts.

Main Results:

  • Out of 3439 pediatric encounters, 13 underwent resuscitative thoracotomy and 66 received CPR without thoracotomy (matched mechanisms).
  • The thoracotomy group had significantly higher median thorax injury scores (3 vs. 0, p=0.001).
  • A trend towards improved survival to discharge was observed in the thoracotomy group (31% vs. 9%, p=0.108), with the youngest survivor being an infant.

Conclusions:

  • Resuscitative thoracotomy in pediatric combat casualties showed a trend toward higher survival to hospital discharge compared to CPR alone.
  • Further research and improved data collection are necessary to confirm the survival benefit of this procedure in resource-limited combat settings.
  • Enhanced documentation and provider training are crucial for optimizing care for pediatric trauma patients in deployed environments.
Abstract

Keywords:
CardiopulmonaryCombatPediatricResuscitationThoracotomyTrauma

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