Emergency thoracotomy for blunt thoracic trauma.

OBJECTIVES The indications for emergency thoracotomy are controversial for blunt trauma. The best results were seen in those patients who were stable enough to undergo thoracotomy in the operating theatre and survived the operation. METHODS The hospital records of 29 patients who underwent emergency thoracotomy for blunt thoracic trauma were reviewed. RESULTS Of 964 patients with thoracic trauma, 745 (77.3%) sustained blunt injury and 29 of these patients (3.9%) required emergency thoracotomy. Six patients underwent emergency department thoracotomy for blunt cardiac trauma and only one of them survived (16.7%). Of the 23 patients who had emergency thoracotomy at the operating theatre, 2 died in the early postoperative period due to pulmonary embolism (8.7%) and 21 of them survived (91.3%). CONCLUSION The results of emergency department thoracotomy in our series were extremely poor compared with the results of other reports, mainly due to rapid deterioration of hemodynamic condition caused by severe cardiac injury. The outcome from emergency thoracotomy in the operating theatre was encouraging, due particularly to the patients' status being stable enough to be transferred to a fully equipped operating theatre. We emphasize the importance of emergency medicine education programmes on rapid diagnosis of traumatic injuries with early intervention, and adequate hemodynamic and respiratory support.

[1]  M. Sebastian.  Trauma, 4th ed , 2001 .

[2]  S. Nakai,et al.  Pulmonary resection for lung trauma. , 1997, The Annals of thoracic surgery.

[3]  A. Bleetman,et al.  Review of emergency thoracotomy for chest injuries in patients attending a UK Accident and Emergency department. , 1996, Injury.

[4]  M. K. Allen,et al.  Double jeopardy: thoracoabdominal injuries requiring surgical intervention in both chest and abdomen. , 1995, The Journal of trauma.

[5]  G. Tominaga,et al.  Emergency thoracotomy with lung resection following trauma. , 1993, The American surgeon.

[6]  P. Pepe,et al.  Emergency center thoracotomy: impact of prehospital resuscitation. , 1992, The Journal of trauma.

[7]  M. Brautigan.  Controversies in resuscitation Patient selection in emergency thoracotomy , 1991 .

[8]  M. Copass,et al.  Reappraisal of emergency room thoracotomy in a changing environment. , 1990, The Journal of trauma.

[9]  J. Knottenbelt,et al.  Should emergency room thoracotomy be reserved for cases of cardiac tamponade? , 1991, Injury.

[10]  M. Brautigan.  Patient selection in emergency thoracotomy. , 1991, Resuscitation.

[11]  S. Shackford,et al.  Thoracotomy during trauma resuscitations--an appraisal by board-certified general surgeons. , 1989, The Journal of trauma.

[12]  K. Mattox,et al.  Epidemiology of chest trauma. , 1989, The Surgical clinics of North America.

[13]  R. Ivatury,et al.  The injured heart. , 1989, The Surgical clinics of North America.

[14]  A Rodriguez,et al.  Blunt Thoracic Trauma Analysis of 515 Patients , 1987, Annals of surgery.

[15]  G. Ewy,et al.  Time limitations for open‐chest cardiopulmonary resuscitation from cardiac arrest , 1985, Critical care medicine.

[16]  M. Copass,et al.  Prehospital cardiopulmonary resuscitation of the critically injured patient. , 1984, American journal of surgery.

[17]  E. Moore,et al.  Rationale for selective application of Emergency Department thoracotomy in trauma. , 1982, The Journal of trauma.

[18]  E. Moore,et al.  Postinjury thoracotomy in the emergency department: a critical evaluation. , 1979, Surgery.

[19]  E. Moore,et al.  Emergency department thoracotomy. , 1979, JACEP.

[20]  L. Kozloff,et al.  Indications for early thoracotomy in the management of chest trauma. , 1976, The Annals of thoracic surgery.

[21]  E. Polák.  [INJURY TO THE LUNG AND PLEURA BY GLASS SPLINTERS]. , 1963, Rozhledy v chirurgii : mesicnik Ceskoslovenske chirurgicke spolecnosti.

[22]  Burnier Ep.  INDICATIONS FOR THORACOTOMY , 1963 .

[23]  E. Burnier.  [INDICATIONS FOR THORACOTOMY]. , 1963, Arquivos de oncologia.