Abstract:
BACKGROUND : An Emergency Room Thoracotomy (ERT ) is a resource-intensive, high-risk procedure in which rapid
decision-making is essential. In a resource-constrained system, identification of the group of patients that could
achieve the best outcome will avoid futile use. Incorporating physiological and metabolic parameters at the time of
arrival to the emergency department into the management algorithm may assist with better patient selection and could
improve outcomes.
MATERIALS AND METHODS : A retrospective review of the results of subjects who underwent Emergency Room
Thoracotomy at a Level 1 Academic Trauma Center over a 13-year period (01 January 2005 to 31 December 2017)
was conducted. Mechanism of injury, physiological and metabolic parameters, anatomical injuries, Injury Severity
Score (ISS), calculated Revised Trauma score (cRTS), volume and type of fluids administered, and mortality were
analyzed comparing survivors and non-survivors.
RESULTS : One hundred and ten (n=110) patients underwent ERT during the study period. Variables such as the
mechanism of injury, physiological and metabolic parameters, type, and volume of fluids administered did not show
any statistically significant influence in the final outcome. Penetrating cardiac and chest trauma had better survival
(40.6 % and 20 % respectively) compared to those with thoraco-abdominal, abdominal, pelvic, and femoral vessel
trauma. Overall survival was 21,8%.
CONCLUSIONS : In a resource-constrained environment an Emergency Room Thoracotomy should be performed in
patients with a thoracic injury, especially cardiac, to achieve the best possible outcome.
