Improving survival after an emergency resuscitative thoracotomy: A 5-year review of the Trauma Quality Improvement Program

Bellal A Joseph, Muhammad Khan, Faisal Jehan, Rifat - Latifi, Peter M Rhee

Research output: Contribution to journalReview article

2 Citations (Scopus)

Abstract

background Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. Methods A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed. results 2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism. Discussion Utilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided. Level of evidence Level III, prognostic studies.

Original languageEnglish (US)
Article numbere000201
JournalTrauma Surgery and Acute Care Open
Volume3
Issue number1
DOIs
StatePublished - Jan 1 2018

Fingerprint

Thoracotomy
Quality Improvement
Emergencies
Survival
Wounds and Injuries
Survival Rate
Nonpenetrating Wounds
Population Growth
Survival Analysis
Survivors
Thorax
Regression Analysis
Outcome Assessment (Health Care)

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

Cite this

@article{44823a57017e4661a74330655f073cfb,
title = "Improving survival after an emergency resuscitative thoracotomy: A 5-year review of the Trauma Quality Improvement Program",
abstract = "background Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. Methods A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed. results 2229 patients underwent ERT, mean age was 37±17 years, 81{\%} were male. Overall 56{\%} patients had penetrating mechanism, location of major injury was thorax in 48, and 71{\%} had signs of life (SOL) on arrival. The overall survival rate was 9.6{\%}. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9{\%} to 11.3{\%} (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism. Discussion Utilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided. Level of evidence Level III, prognostic studies.",
author = "Joseph, {Bellal A} and Muhammad Khan and Faisal Jehan and Latifi, {Rifat -} and Rhee, {Peter M}",
year = "2018",
month = "1",
day = "1",
doi = "10.1136/tsaco-2018-000201",
language = "English (US)",
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journal = "Trauma Surgery and Acute Care Open",
issn = "2397-5776",
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TY - JOUR

T1 - Improving survival after an emergency resuscitative thoracotomy

T2 - A 5-year review of the Trauma Quality Improvement Program

AU - Joseph, Bellal A

AU - Khan, Muhammad

AU - Jehan, Faisal

AU - Latifi, Rifat -

AU - Rhee, Peter M

PY - 2018/1/1

Y1 - 2018/1/1

N2 - background Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. Methods A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed. results 2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism. Discussion Utilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided. Level of evidence Level III, prognostic studies.

AB - background Advancement in trauma care has led to the evolution of emergency resuscitative thoracotomy (ERT) for the revival of trauma patients. We now have more precise understanding of selecting suitable patients for achieving optimal outcomes. The aim of our study was to analyze the utilization and survival trends during the past 5 years, as well as factors that influence survival after ERT. Methods A 5-year (2010-2014) analysis of all trauma patients ≥18 years who underwent ERT in the American College of Surgeons Trauma Quality Improvement Program. Outcome measures were utilization rates and survival trends after ERT during the 5-year period. Regression analysis was performed. results 2229 patients underwent ERT, mean age was 37±17 years, 81% were male. Overall 56% patients had penetrating mechanism, location of major injury was thorax in 48, and 71% had signs of life (SOL) on arrival. The overall survival rate was 9.6%. From 2010–2014 ERT utilization has decreased from 331/100 000 to 243/100 000 trauma admissions (p=0.002) and the survival rate has improved from 7.9% to 11.3% (p<0.001). On regression, the independent predictors of survival were penetrating mechanism, age<60 years, SOL on arrival, no prehospital CPR and ISS. No patient aged >60 years with a blunt mechanism of injury (MOI) survived, and there were no survivors above the age of 70 years, regardless of injury mechanism. Discussion Utilization of ERT has been decreased during the study period along with improved survival rates. The results of our study demonstrate that performing ERT on patients aged >60 years with a blunt MOI or on any patient aged ≥70 years, regardless of MOI, is futile and should be avoided. Level of evidence Level III, prognostic studies.

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U2 - 10.1136/tsaco-2018-000201

DO - 10.1136/tsaco-2018-000201

M3 - Review article

AN - SCOPUS:85061294202

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JO - Trauma Surgery and Acute Care Open

JF - Trauma Surgery and Acute Care Open

SN - 2397-5776

IS - 1

M1 - e000201

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