Survival after emergency department thoracotomy: Review of published data from the past 25 years

Peter M Rhee, Jose Acosta, Amy Bridgeman, Dennis Wang, Marion Jordan, Norman Rich

Research output: Contribution to journalArticle

239 Citations (Scopus)

Abstract

Background: Emergency department thoracotomy (EDT) has become standard therapy for patients who acutely arrest after injury. Patient selection is vitally important to achieve optimal outcomes without wasting valuable resources. The aim of this study was to determine the main factors that most influence survival after EDT. Study Design: Twenty-four studies that included 4,620 cases from institutions that reported EDT for both blunt and penetrating trauma during the past 25 years were reviewed. The primary outcomes analyzed were in-hospital survival rates. Results: EDT had an overall survival rate of 7.4%. Normal neurologic outcomes were noted in 92.4% of surviving patients. Factors reported as influencing outcomes were the mechanism of injury (MOI), location of major injury (LOMI), and signs of life (SOL). Survival rates for MOI were 8.8% for penetrating injuries and 1.4% for blunt injuries. When penetrating injuries were further separated, the survival rates were 16.8% for stab wounds and 4.3% for gunshot wounds. For the LOMI, survival rates were 10.7% for thoracic injuries, 4.5% for abdominal injuries, and 0.7% for multiple injuries. If the LOMI was the heart, the survival rate was the highest at 19.4%. The third factor influencing outcomes was SOL. If SOL were present on arrival at the hospital, survival rate was 11.5% in contrast to 2.6% if none were present. SOL present during transport resulted in a survival rate of 8.9%. Absence of SOL in the field yielded a survival rate of 1.2%. There was no clear single independent preoperative factor that could uniformly predict death. Conclusions: The best survival results are seen in patients who undergo EDT for thoracic stab injuries and who arrive with SOL in the emergency department. All three factors-MOI, LOMI, and SOL-should be taken into account when deciding whether to perform EDT. Uniform reporting guidelines are needed to further elucidate the role of EDT taking into account the combination of MOI, LOMI, and SOL. (C) 2000 by the American College of Surgeons.

Original languageEnglish (US)
Pages (from-to)288-298
Number of pages11
JournalJournal of the American College of Surgeons
Volume190
Issue number3
DOIs
StatePublished - Mar 2000
Externally publishedYes

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Thoracotomy
Hospital Emergency Service
Survival
Wounds and Injuries
Survival Rate
Thoracic Injuries
Stab Wounds
Abdominal Injuries
Gunshot Wounds
Nonpenetrating Wounds
Multiple Trauma
Patient Selection
Nervous System
Heart Rate
Guidelines

ASJC Scopus subject areas

  • Surgery

Cite this

Survival after emergency department thoracotomy : Review of published data from the past 25 years. / Rhee, Peter M; Acosta, Jose; Bridgeman, Amy; Wang, Dennis; Jordan, Marion; Rich, Norman.

In: Journal of the American College of Surgeons, Vol. 190, No. 3, 03.2000, p. 288-298.

Research output: Contribution to journalArticle

Rhee, Peter M ; Acosta, Jose ; Bridgeman, Amy ; Wang, Dennis ; Jordan, Marion ; Rich, Norman. / Survival after emergency department thoracotomy : Review of published data from the past 25 years. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 3. pp. 288-298.
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abstract = "Background: Emergency department thoracotomy (EDT) has become standard therapy for patients who acutely arrest after injury. Patient selection is vitally important to achieve optimal outcomes without wasting valuable resources. The aim of this study was to determine the main factors that most influence survival after EDT. Study Design: Twenty-four studies that included 4,620 cases from institutions that reported EDT for both blunt and penetrating trauma during the past 25 years were reviewed. The primary outcomes analyzed were in-hospital survival rates. Results: EDT had an overall survival rate of 7.4{\%}. Normal neurologic outcomes were noted in 92.4{\%} of surviving patients. Factors reported as influencing outcomes were the mechanism of injury (MOI), location of major injury (LOMI), and signs of life (SOL). Survival rates for MOI were 8.8{\%} for penetrating injuries and 1.4{\%} for blunt injuries. When penetrating injuries were further separated, the survival rates were 16.8{\%} for stab wounds and 4.3{\%} for gunshot wounds. For the LOMI, survival rates were 10.7{\%} for thoracic injuries, 4.5{\%} for abdominal injuries, and 0.7{\%} for multiple injuries. If the LOMI was the heart, the survival rate was the highest at 19.4{\%}. The third factor influencing outcomes was SOL. If SOL were present on arrival at the hospital, survival rate was 11.5{\%} in contrast to 2.6{\%} if none were present. SOL present during transport resulted in a survival rate of 8.9{\%}. Absence of SOL in the field yielded a survival rate of 1.2{\%}. There was no clear single independent preoperative factor that could uniformly predict death. Conclusions: The best survival results are seen in patients who undergo EDT for thoracic stab injuries and who arrive with SOL in the emergency department. All three factors-MOI, LOMI, and SOL-should be taken into account when deciding whether to perform EDT. Uniform reporting guidelines are needed to further elucidate the role of EDT taking into account the combination of MOI, LOMI, and SOL. (C) 2000 by the American College of Surgeons.",
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N2 - Background: Emergency department thoracotomy (EDT) has become standard therapy for patients who acutely arrest after injury. Patient selection is vitally important to achieve optimal outcomes without wasting valuable resources. The aim of this study was to determine the main factors that most influence survival after EDT. Study Design: Twenty-four studies that included 4,620 cases from institutions that reported EDT for both blunt and penetrating trauma during the past 25 years were reviewed. The primary outcomes analyzed were in-hospital survival rates. Results: EDT had an overall survival rate of 7.4%. Normal neurologic outcomes were noted in 92.4% of surviving patients. Factors reported as influencing outcomes were the mechanism of injury (MOI), location of major injury (LOMI), and signs of life (SOL). Survival rates for MOI were 8.8% for penetrating injuries and 1.4% for blunt injuries. When penetrating injuries were further separated, the survival rates were 16.8% for stab wounds and 4.3% for gunshot wounds. For the LOMI, survival rates were 10.7% for thoracic injuries, 4.5% for abdominal injuries, and 0.7% for multiple injuries. If the LOMI was the heart, the survival rate was the highest at 19.4%. The third factor influencing outcomes was SOL. If SOL were present on arrival at the hospital, survival rate was 11.5% in contrast to 2.6% if none were present. SOL present during transport resulted in a survival rate of 8.9%. Absence of SOL in the field yielded a survival rate of 1.2%. There was no clear single independent preoperative factor that could uniformly predict death. Conclusions: The best survival results are seen in patients who undergo EDT for thoracic stab injuries and who arrive with SOL in the emergency department. All three factors-MOI, LOMI, and SOL-should be taken into account when deciding whether to perform EDT. Uniform reporting guidelines are needed to further elucidate the role of EDT taking into account the combination of MOI, LOMI, and SOL. (C) 2000 by the American College of Surgeons.

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