Resuscitative thoracotomy in children and adolescents

Accidental injury continues as the leading cause of mortality in children and adolescents. With the recent push for improvement in emergency medical services and specialized trauma centers for this age group, more moribund patients can be expected to reach these centers. Multiple reports document the efficacy of resuscitative thoracotomy in the moribund adult trauma victim, but published reports of this technique in children and adolescents are lacking. From January 1981 to July 1986, 19 patients ranging in age from 4 to 18 years (mean 14) underwent resuscitative thoracotomy. Eleven patients sustained penetrating trauma while eight sustained injuries from blunt trauma. Five patients survived and were discharged from the hospital (26%). There were no survivors in the 0-15 year age group in five penetrating injuries and four blunt trauma victims. This review confirms the efficacy of resuscitative thoracotomy in the patient with penetrating trauma. Salvage in the blunt trauma victim is possible, but less than in penetrating injuries (12.5% versus 36%). Further studies in this age group will be necessary to establish appropriate guidelines for the use of RT in children and adolescents.