Emergency Department Thoracotomy: Time to Stop - A Trauma Video Review

Emergency department thoracotomy (EDT) can restore spontaneous circulation in selected trauma patients as a bridge to definitive operating room repair. Compared with medical cardiopulmonary resuscitation, there is little guidance on EDT resuscitation duration in trauma. We hypothesized that prolonged EDT resuscitation efforts was not associated with durable return of spontaneous circulation (ROSC) (ROSC with survival to operating room).

This institutional review board approved study was performed at a level 1 trauma center from January 2022 to January 2023. Trauma bay video and electronic medical data were reviewed on patients undergoing EDT. Patients with inadequate video data, known to be under the age of 18, known to be a prisoner, or known to be pregnant were excluded. Resuscitation duration was defined as EDT incision start to ROSC and/or death pronouncement.

Seven of 41 patients (39 gunshots, 2 blunt) achieved ROSC after EDT. Comparing patients achieving durable ROSC versus not, there was no difference in median time until incision (ROSC 3.2 min versus no ROSC 2.7 min, P = 0.85) or resuscitation duration (ROSC 8.2 min versus no ROSC 10.5 min, P = 0.62). No patients achieved durable ROSC after 20 min of resuscitation. Two of seven durable ROSC patients survived through hospital discharge-both were neurologically intact and achieved durable ROSC within 10 min.

In this trauma video review study, prolonged EDT resuscitation times was not associated with increased durable ROSC rates. Prolonged resuscitations should prompt critical re-evaluation for futility.