Abstract
The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome. 27 ETs were performed: 21 after blunt trauma and 6 after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40.5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long-term neurological sequelae were reported. The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centres have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient’s survival; the possibility of organ donation should be taken into consideration as well.
Highlights
Emergency thoracotomy (ET) is a potentially life-saving procedure with outcomes being the most favourable in penetrating trauma [1, 2], when pre-hospital cardio-pulmonary resuscitation (CPR) does not exceed 15 min [3], asystole is the presenting rhythm without pericardial tamponade [3] and the America College of Surgeons Committee on Trauma (ACS-COT) practice guidelines are followed [4]
Penetrating trauma is an established indication for ET with good outcomes, especially when a single cardiac injury is detected and repaired, relieving a cardiac tamponade
ET in blunt trauma is a debated indication since it has poor outcomes and limited cost–benefits
Summary
Emergency thoracotomy (ET) is a potentially life-saving procedure with outcomes being the most favourable in penetrating trauma [1, 2], when pre-hospital CPR does not exceed 15 min [3], asystole is the presenting rhythm without pericardial tamponade [3] and the America College of Surgeons Committee on Trauma (ACS-COT) practice guidelines are followed [4] This is based in North America where penetrating injury is the predominant mechanism of injury (MOI) and the trauma systems are equipped and trained to conduct ET [1]. This study aims to review and critically analyse data surrounding ETs performed at the Bologna
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callDisclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
