A 9 year cohort of resuscitative thoracotomies for blunt and penetrating trauma at the Royal Adelaide Hospital
Trauma and Emergency Care
Emergency room thoracotomies (ERT) are a last ditch effort in salvaging dying trauma patients. The Royal Adelaide Hospital (RAH) has a protocol for the use of ERT with thoracotomy being initiated when the systolic BP remains <60mmHg despite maximal resuscitation. ERT is in the form of clam-shell thoracotomy as it yields excellent exposure. This study analyses the outcome of these patients in our institution. Methods: Patients who underwent ERT were identified from the RAH trauma database and
... uma database and reviewed. Patients were divided into penetrating or blunt trauma and overall mortality and major morbidity were considered as primary study endpoints. Results: From 2005 to January 2014, 72 patients underwent ERT. 42 were for blunt and 30 were for penetrating trauma. Overall survival was 66.67% and 23.8% for penetrating and blunt trauma patients respectively. 83.3% of emergency room thoracotomies successfully restored spontaneous circulations and these patients were transferred from the emergency department (ED) to the operating theatre for further treatment. Blunt ERT performed within 10 minutes of arrival had 0% survival while penetrating ERT within first 10 minutes had a 33.33% survival. If the first 10 minutes of blunt ERT's were excluded, blunt ERT survival was 33.3%. One patient developed a CVA. Blunt cardiac ruptures had 88.9% mortality, whilst penetrating cardiac injuries had a 69% survival. Conclusion: This study has shown that ERT in penetrating and blunt trauma patients who are in extremis can achieve a survival rate of 66.7% and 23.8% respectively.