Occupational Exposures During Emergency Department Thoracotomies

Recent studies investigating emergency department (ED) thoracotomies (EDTs) focus on patient outcomes to identify optimal candidates for this procedure. However, there is limited but concerning literature regarding healthcare workers occupational exposures resulting from EDT. In this study, we compare rates of blood-borne exposure to immediate procedural success (i.e., regaining pulses) as well as patient outcome.

A retrospective chart review of the trauma registry was performed from January 2019 to January 2023. We included all trauma patients who underwent EDT during the study period. 58 patients met the inclusion criteria and were reviewed, and no patients were excluded. The primary endpoint was the rate of occupational exposure as defined by mucous membrane or percutaneous exposure to the patient's blood during the procedure. Additional endpoints include rate of survival to operating room, intensive care unit (ICU), and discharge, type of exposure, Glasgow Coma Score score, and blood products transfused.

Of the 58 patients, 10 EDTs (17%) had reported healthcare occupational exposure, 24 patients (41%) were resuscitated in the ED and moved to the OR or the ICU. 9 patients (16%) survived the OR, with 2 patients (3%) surviving to discharge from the hospital. Of the 10 patients with reported exposures, 4 (40%) regained spontaneous circulation in the ED, 2 patients (20%) survived the OR to the post anesthesia care unit and ICU, but neither survived to discharge (0%). Of the 48 patients without exposures reported, 20 (42%) regained spontaneous circulation in the ED, 7 (15%) survived to the ICU after the OR, and 2 (4%) survived to discharge. Of the 9 patients that survived the OR, 3 showed improvement in neurologic status shown by an improved Glasgow Coma Score.

The noted rate of healthcare worker exposures during these procedures is higher than expected. The rate of survival to the operating room and subsequently to the ICU was higher than current reported rates. Further research needs to be done to investigate ways to improve training and protocols to make this procedure safer for the patient and the team of providers.