A 9 year cohort of resuscitative thoracotomies for blunt and penetrating trauma at the Royal Adelaide Hospital

Abstract

Purpose: Emergency Resuscitative Thoracotomy (ERT) is a last ditch effort in salvaging dying trauma patients. The Royal Adelaide Hospital (RAH) has a protocol for the use of ERT with thoracotomy being initiated when central pulses are absent or lost (usually meaning systolic BP<60 mmHg) despite maximal resuscitation. ERT is in the form of clamshell thoracotomy as it yields better exposure. This study analyses the outcome of these patients in our institution. Methodology: Patients who underwent ERT were identified from the RAH trauma database and reviewed. Patients were divided into penetrating or blunt trauma, and the study endpoints were overall mortality and major morbidity. Results: From 2005 to January 2014, 72 patients underwent ERT. 42 were for blunt and 30 were for penetrating trauma. Overall survival rate was 66.7% for penetrating trauma and 23.8% for blunt trauma. 83.3% of ERT successfully restored spontaneous circulations and these patients were transferred from the emergency department to the operating theatre for further surgery. Patients with blunt trauma who required ERT performed within 10 minutes of arrival had 0% survival, while ERT for penetrating trauma within the first 10 minutes had a 33.3% survival. If the first 10 minutes of blunt ERT were excluded, the survival rate was 33.3%. One patient developed a cerebrovascular accident after ERT. Blunt cardiac ruptures had 88.9% mortality, whilst penetrating cardiac injuries had a 69% survival. Conclusion: The involvement of experienced trauma surgeons in ERT allows survival of 66.7% in moribund penetrating trauma patients and up to 33.3% survival in selected moribund blunt trauma patients.