Outcome of Patients Underwent Emergency Department Thoracotomy and Its Predictive Factors

Shahram Paydar--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Abdoshahid Moghaninasab--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Elham Asiaei--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Golnar Sabetian Fard Jahromi--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Shahram Bolandparvaz--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran,
Hamidreza Abbasi--- Trauma Research Center, Shiraz University of Medical Sciences, Shiraz, Iran

Abstract


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Introduction: Emergency department thoracotomy (EDT) may serve as the last survival chance for patients who arrive at hospital in extremis. It is considered as an effective tool for improvement of traumatic patients’ outcome. The present study was done with the goal of assessing the outcome of patients who underwent EDT and its predictive factors. Methods: In the present study, medical charts of 50 retrospective and 8 prospective cases underwent emergency department thoracotomy (EDT) were reviewed during November 2011 to June 2013. Comparisons between survived and died patients were performed by Mann-Whitney U test and the predictive factors of EDT outcome were measured using multivariate logistic regression analysis. P < 0.05 considered statistically significant. Results: Fifty eight cases of EDT were enrolled (86.2% male). The mean age of patients was 43.27±19.85 years with the range of 18-85. The mean time duration of CPR was recorded as 37.12±12.49 minutes. Eleven cases (19%) were alive to be transported to OR (defined as ED survived). The mean time of survival in ED survived patients was 223.5±450.8 hours. More than 24 hours survival rate (late survived) was 6.9% (4 cases). Only one case (1.7%) survived to discharge from hospital (mortality rate=98.3%). There were only a significant relation between ED survival and SBP, GCS, CPR duration, and chest trauma (p=0.04). The results demonstrated that initial SBP lower than 80 mmHg (OR=1.03, 95% CI: 1.001-1.05, p=0.04) and presence of chest trauma (OR=2.6, 95% CI: 1.75-3.16, p=0.02) were independent predictive factors of EDT mortality. Conclusion: The findings of the present study showed that the survival rate of trauma patients underwent EDT was 1.7%. In addition, it was defined that falling systolic blood pressure below 80 mmHg and blunt trauma of chest are independent factors that along with poor outcome.


Keywords


Thoracotomy; emergency department; cardiopulmonary resuscitation; heart arrest; outcome assessment

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References


Flynn TC, Ward RE, Miller PW. Emergency department thoracotomy. Ann Emerg Med. 1982;11(8):413-6.

Sersar SI, AlAnwar MA. Emergency thoracotomies: Two center study. J Emerg Trauma Shock. 2013;6(1):11-5.

Seamon MJ, Chovanes J, Fox N, et al. The use of emergency department thoracotomy for traumatic cardiopulmonary arrest. Injury. 2012;43(9):1355-61.

Tan B, Pothiawala S, Ong M. Emergency thoracotomy: a review of its role in severe chest trauma. Minerva Chir. 2013;68(3):241-50.

Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006;1(1):4.

Lorenz HP, Steinmetz B, Lieberman J, Schecter WP, Macho JR. Emergency thoracotomy: survival correlates with physiologic status. J Trauma. 1992;32(6):780-8.

Millham FH, Grindlinger GA. Survival determinants in patients undergoing emergency room thoracotomy for penetrating chest injury. J Trauma. 1993;34(3):332-6.

Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190(3):288-98.

Rabinovici R, Bugaev N. Resuscitative Thoracotomy: An Update. Scand J Surg. 2014;103(2):112-9.

Burlew CC, Moore EE. Initial Trauma Management, Resuscitative Thoracotomy. Encyclopedia Intensive Care Med. 2012:1238-44.

Khorsandi M, Skouras C, Shah R. Is there any role for resuscitative emergency department thoracotomy in blunt trauma? Interact Cardiovasc Thorac Surg. 2013;16(4):509-16.

Mollberg NM, Glenn C, John J, et al. Appropriate use of emergency department thoracotomy: implications for the thoracic surgeon. Ann Thorac Surg. 2011;92(2):455-61.

Powell DW, Moore EE, Cothren CC, et al. Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation? J Am Coll Surg. 2004;199(2):211-5.

Vassiliu P, Yilmaz T, Degiannis E. On the Ideal Emergency Thoracotomy Incision. World J Surg. 2014;38(4):1001-2.

Thomas MO, Ogunleye EO. Emergency Thoracotomy: Indications and Management Challenges in a Developing World. World J Cardiovasc Surg. 2012;2:1.

Brown SE, Gomez GA, Jacobson LE, Scherer 3rd T, McMillan RA. Penetrating chest trauma: should indications for emergency room thoracotomy be limited? Am Surg. 1996;62(7):530-3.

Passos EM, Engels PT, Doyle JD, et al. Societal costs of inappropriate emergency department thoracotomy. J Am Coll Surg. 2012;214(1):18-25.

Wyrick DL, Dassinger MS, Bozeman AP, Porter A, Maxson RT. Hemodynamic variables predict outcome of emergency thoracotomy in the pediatric trauma population. J Pediatr Surg. 2014;[In press].

Mazzorana V, Smith RS, Morabito DJ, Brar HS. Limited utility of emergency department thoracotomy. The American surgeon. 1994;60(7):516-20.

Champion J, McKernan J. Comparison of minimally invasive thoracoscopy versus open thoracotomy for staging lung cancer. Int Surg. 1995;81(3):235-6.

Velmahos GC, Degiannis E, Souter I, Allwood AC, Saadia R. Outcome of a strict policy on emergency department thoracotomies. Arch Surg. 1995;130(7):774-7.

Keller D, Kulp H, Maher Z, Santora TA, Goldberg AJ, Seamon MJ. Life after near death: Long-term outcomes of emergency department thoracotomy survivors. Journal of Trauma and Acute Care Surgery. 2013;74(5):1315-20.




DOI: http://dx.doi.org/10.22037/emergency.v2i3.6563

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