TY - JOUR
T1 - Outcomes and indications for emergency thoracotomy after adoption of a more liberal policy in a western European level 1 trauma centre
T2 - 8-year experience
AU - Bologna Trauma Team collaborative group
AU - Segalini, Edoardo
AU - Di Donato, Luca
AU - Birindelli, Arianna
AU - Piccinini, Alice
AU - Casati, Alberto
AU - Coniglio, Carlo
AU - Di Saverio, Salomone
AU - Tugnoli, Gregorio
AU - Gordini, Giovanni
AU - Biscardi, Andrea
AU - Parri, Sergio Nicola Forti
AU - Bonfanti, Barbara
AU - Kawamukai, Kenji
AU - Lacava, Nicola
AU - Lupi, Cristian
AU - Cavalli, Piergiorgio
AU - Ferri, Enrico
AU - Giugni, Aimone
AU - Trentini, Sara
AU - Baldazzi, Marzia
AU - Villani, Silvia
AU - McKee, Jessica
AU - Affinita, Antonio
AU - Mengozzi, Elena
AU - Montanari, Nicola
AU - Podda, Mauro
AU - Kwan, Sherman
PY - 2019/3/1
Y1 - 2019/3/1
N2 - The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome. 27 ETs were performed: 21 after blunt trauma and 6 after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40.5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long-term neurological sequelae were reported. The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centres have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient’s survival; the possibility of organ donation should be taken into consideration as well.
AB - The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome. 27 ETs were performed: 21 after blunt trauma and 6 after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40.5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long-term neurological sequelae were reported. The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centres have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient’s survival; the possibility of organ donation should be taken into consideration as well.
KW - Aortic cross-clamping
KW - Blunt trauma
KW - Cardiac repair
KW - Clamshell thoracotomy
KW - Emergency department thoracotomy
KW - Emergency resuscitative thoracotomy
KW - Emergency thoracotomy
KW - Open cardiac massage
KW - Penetrating trauma
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UR - http://www.scopus.com/inward/citedby.url?scp=85063234033&partnerID=8YFLogxK
U2 - 10.1007/s13304-018-0607-4
DO - 10.1007/s13304-018-0607-4
M3 - Article
C2 - 30588565
AN - SCOPUS:85063234033
VL - 71
SP - 121
EP - 127
JO - Updates in Surgery
JF - Updates in Surgery
SN - 2038-131X
IS - 1
ER -