Futility indications in resuscitative thoracotomy: A retrospective observational study evaluating practice guidelines

Area of Science:

• Trauma Surgery
• Emergency Medicine
• Critical Care

Background:

• Resuscitative thoracotomies (RTs) are resource-intensive and carry risks for surgical teams.
• Refinement of RT guidelines is ongoing due to limited resources and team safety concerns.
• This study evaluated RT futility indicators alongside institutional guideline changes.

Purpose of the Study:

• To assess the effectiveness of institutional practice guideline changes on resuscitative thoracotomy (RT) utilization and outcomes.
• To identify futility indicators for RT in trauma patients.

Main Methods:

• Retrospective review of 78 thoracotomies (January 2017-July 2023) at a Level 1 Trauma Center.
• Classification of procedures as RT or non-resuscitative (non-RT).
• Collection of injury characteristics, demographics, procedure details, and mortality outcomes.

Main Results:

• Of 78 thoracotomies, 56 (71.8%) were RTs, primarily for penetrating injuries.
• RT procedure mortality was 67.9%, with 10.7% survival to discharge.
• Fixed dilated pupils, no signs of life, and pre-hospital CPR were associated with non-survival.

Conclusions:

• RT utilization and mortality rates were unchanged by stricter institutional guidelines.
• Further refinement of RT guidelines, particularly patient selection criteria, is needed.
• Consideration of witnessed cardiac arrest and pupillary response as futility indicators is recommended.