Blood product use in emergency resuscitative thoracotomy: A nationwide analysis

Emergency resuscitative thoracotomy survival rates range widely depending on the mechanism of injury and signs of life at presentation. Given ongoing shortages of blood products, we sought to examine blood product use across this patient population and corresponding survival.

We identified patients in the American College of Surgeons-Trauma Quality and Improvement Program (2017-2019) undergoing an emergency resuscitative thoracotomy within 30 minutes of hospital arrival. The primary outcome was the number of packed red blood cells units transfused within 4 hours. Secondary outcomes were the number of units of plasma and platelets transfused and overall survival. The number of uvnits of blood products transfused to observe 1 survivor was calculated by dividing the total number of units transfused by the number of survivors.

A total of 1,231 patients were included. The median age was 36, 84.6% were male, 69.2% had penetrating trauma, and 40.4% presented with signs of life. The overall survival was 7.3%, and the median number of packed red blood cells transfused within 4 hours was 3.7 [interquartile range, 1.0-9.4]. Patients with penetrating trauma and signs of life had a survival rate of 17.1% and received a median of 8.0 [3.0-17.0] packed red blood cells. Patients presenting with blunt trauma and no signs of life had a 1.1% survival and received a median of 2.0 packed red blood cells [0.9-6.0]. For patients with stab wounds arriving with signs of life, a total number of 30 packed red blood cell units was transfused to observe 1 survivor. For blunt trauma without signs of life, a total of 485 units were transfused to observe 1 survivor.

Given the near futility of emergency resuscitative thoracotomy in patients with blunt trauma presenting with no signs of life, coupled with the ongoing national shortage of blood, we recommend allocating transfusion resources to patients with penetrating trauma and to patients with blunt trauma presenting with signs of life.