The objective of this study was to evaluate the use of emergency
thoracotomy in our institution in an effort to determine whether this procedure is both beneficial and cost effective in blunt and/or penetrating
trauma. We conducted a retrospective review of charts and coroner's reports. Our setting was a Level I trauma center in a tertiary-care facility. We examined the cases of
trauma patients presenting to the trauma center over a 2-year period. Of 2490 patients who presented to the emergency department over the study period 41 underwent early
thoracotomy. Twelve of these were excluded from the study because their cases were not truly emergent. Of the remaining 29 ten were admitted for penetrating
injuries and 19 for
blunt injuries. The average Injury Severity Scores for penetrating and
blunt injuries were 30 and 40 respectively. There were four blunt
trauma patients who died in the emergency department, 15 went to the operating room, and five who survived to go to the intensive care unit. All blunt
trauma patients requiring emergency
thoracotomy died within 9 days of presentation. Of the ten
penetrating wound patients two died in the emergency department, four died in the operating room, and four went to the intensive care unit after surgery. One of the four patients who went to the intensive care unit died approximately 6 days after injury. The other three patients survived and are now living normal productive lives. All survivors of penetrating
trauma who required emergency
thoracotomy had their procedure performed in the operating room. Overall survival rates for penetrating and blunt
trauma were 30 and 0 per cent respectively.
Pericardial tamponade was found in 50 per cent of the penetrating
trauma patients (two of the three survivors) and four of 19 of the blunt
trauma patients. This reinforces the importance of a prompt
pericardiotomy upon opening the chest. At our institution the algorithm for emergency
thoracotomy is liberal and is not cost effective for blunt
trauma. We need to re-evaluate our decision-making process concerning the use of emergency
thoracotomy especially in the blunt
trauma patient. The review also shows the importance of
pericardiotomy when performing an emergency
thoracotomy.