The case records of 200 patients who had emergency
thoracotomy for penetrating
trauma were reviewed. The mortality was 47% (93/200) for the entire series, 27% (21/79) for
stab wounds and 60% (72/121) for
gunshot wounds. Of 55 patients who underwent
thoracotomy in the emergency department, 8 (15%) survived. Twelve patients "dead" at the scene could not be resuscitated. Nineteen patients sustained
cardiac arrest in the ambulance, 3 (16%) of whom survived. Of 19 who had
cardiac arrest in the emergency department, 5 (26%) survived. Of 38 patients who had
cardiac arrest in the ambulance or emergency department, 14 with
stab wounds had a 43% survival and 24 with
gunshot wounds had a survival of only 8%. Patients who underwent
thoracotomy in the operating room (OR) had a higher survival, 68% (99/145). For those with thoracic, extremity, or
neck injuries, survival was 81% (93/115). For those who had an OR
thoracotomy for aortic cross-clamping because of
abdominal injuries, survival was only 17% (5/30). Early
thoracotomy has a place in the management of patients who have
cardiac arrest in the ambulance or emergency department because of penetrating chest, neck, or extremity
injuries, especially if caused by
stab wounds. Cross-clamping of the thoracic aorta for massive abdominal
bleeding should be applied selectively.