Survival determinants in patients undergoing emergency room thoracotomy for penetrating chest injury

Survival determinants were examined in patients undergoing ERT-PCI who were admitted to the Surgical Intensive Care Unit (SICU) between January 1, 1982 and August 1, 1991. Twenty-one of 290 patients undergoing ERT-PCI (aged 14-36 years) were admitted to the SICU. Of the 21, nine survived to discharge with normal neurologic function. Four survived with neurologic impairment. Eight expired 1 to 12 days after admission. The ERT was done immediately upon hospital arrival or subsequently in the Emergency Department for impending arrest despite resuscitation. All survivors had a pulse or blood pressure either in the field or upon arrival in the ER. Seven of nine who survived neurologically intact were awake on arrival in the ER, the other two were moving their extremities. One of four who survived with neurologic impairment was awake on arrival; three were comatose. Five of the eight who died were in full arrest in the field and upon arrival in the ER. Two of these patients were brain dead shortly after SICU arrival. All survivors had vital signs either in the field or on ER arrival. Patients with penetrating chest wounds without vital signs in the field who do not recover vital signs by hospital arrival do not benefit from emergency room thoracotomy. Evidence of mentation in the field or on arrival may predict ultimate neurologic outcome of survivors.