Emergency room thoracotomy (ERT) : a retrospective audit of results

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.