Resuscitative emergency thoracotomy in a Scandinavian trauma hospital—Is it justified?
Accepted 12 June 2006.
Summary
Objective
Resuscitative emergency thoracotomy (ET) is of value in selected (penetrating) trauma patients. Current survival-estimates and recommended guidelines are based on data from the United States. However, reports from European trauma centres are lacking. We report the current experience from a Scandinavian trauma hospital.
Methods
Identification of all consecutive ETs performed during a 5-year period. Data on demographics, and injury severity score (ISS), mechanism and location were recorded. Physiological status on admission (revised trauma score, RTS) and probability of survival (Ps) were calculated. Signs of life (SOL) and need for closed-chest cardiopulmonary resuscitation (CC-CPR) were recorded through the post-injury phase.
Results
Ten patients underwent ET with no survivors. The annual incidence of ET was 0.7 per 100,000 inhabitants during the study period, with an increasing trend during the last years (r=0.74, p=0.014). ETs were performed in 0.7% of all trauma admissions, and in 2.5% of all severely injured patients (ISS≥16). Blunt mechanism dominated; only three had penetrating injuries. Most frequent location of major injury was “multiple” (n=4) and “thoracic” (n=4). The male to female ratio was 7:3. Median age was 51 years (range 21–77). Median ISS was 34.5 (range 26–75), indicating severely injured patients, with seriously deranged physiology (median RTS of 0.0, range 0–6.1) with poor chance of survival (median Ps of 4.4%, range 0–89.5%). Males had significantly lower RTS and Ps (p=0.007 and 0.03, respectively) than females. Eight patients had signs of life at some time post-injury, but only four in the emergency room. Six patients had both pre- and in-hospital CC-CPR. Four patients had additional surgery to ET. Two possible preventable deaths were identified (Ps of 51 and 89%), one in a third trimester pregnancy.
Conclusion
Emergency thoracotomy is a rarely performed procedure in a rather busy Scandinavian trauma hospital, and outcome is dismal. Reevaluation of our decision-making process concerning the use of emergency thoracotomy is needed. How survival data and clinical experience in Europe compare to current figures from North America deserves further attention.
ABSTRACT