Has Nothing Changed? Evaluating a Decade of Emergency Resuscitative Thoracotomy in Blunt Trauma

The 2015 Eastern Association for the Surgery of Trauma guidelines have attempted to establish indications for emergency resuscitative thoracotomy (ERT) to optimize patient selection. The impact of the updated guidelines on the current clinical practice and patient survival remains unknown. In this nationwide analysis, we aim to analyze changes in ERT utilization trends and survival patterns in trauma patients over the last decade.

A retrospective analysis of the ACS-TQIP database (2010-2020) was conducted, including trauma patients aged 18-40 who underwent ERT within one hour of emergency department arrival. The primary outcome was survival to hospital discharge. ERT trends and outcomes were stratified by mechanism of injury and presence of signs of life (SOL) on arrival. The performance rate of ERT was reported as the number of procedures performed per 10,000 trauma admissions, and additionally stratified among patients with blunt trauma presenting without SOL.

Of the 2444 patients included, overall survival was 13.4%. The median age was 27 y, with 66.4% sustaining gunshot wounds, 11.9% stab wounds, and 21.6% presenting with blunt trauma. Survival was highest among patients with stab wounds (30.1%) and lowest in blunt trauma (8.7%). Among blunt trauma patients without SOL, survival was only 1.7% (3 of 173). Despite this, ERT performance in this group increased after 2017, without corresponding improvements in survival. Year-to-year ERT performance varied, with no consistent association with survival trends.

ERT in blunt trauma patients presenting without SOL remains futile. Despite guideline recommendations, ERT continues to be performed in this population at higher rates, highlighting the need for better alignment between evidence-based practices and clinical decision-making.