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2004, Number 2

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Cir Gen 2004; 26 (2)

Emergency thoracotomy: a critical evaluation of the technique

Asensio JA, O’Shanahan G, Petrone P, Costa D, Robin-Lersundi A

Language: Spanish
References: 28
Page: 128-137
PDF size: 104.31 Kb.


ABSTRACT

Objective: Analysis of the literature on the current status of the Emergency Room thoracotomy.
Setting: University hospital.
Data collection: Review of the literature, from the first experiences in its utilization to the most recent studies in the area.
Results: The Emergency Room thoracotomy is part of the armamentarium of the modern trauma surgeon. Since its introduction in the 60s, its use has become widespread and is now part of the resuscitation protocols in all American Trauma Centers. Forty-two series were analyzed, finding 7,035 procedures, of which 551 (7.8%) patients survived. According to the mechanism of injury, 4,482 thoracotomies were performed for penetrating injuries, 500 (11.1%) patients survived, and 2,193 thoracotomies were performed for blunt trauma, 35 (1.6%) of which survived. Fourteen series reported neurological prognoses: of 4,520 patients who underwent Emergency Room thoracotomy, 226 (5%) survived, and 34 (15%) experienced neurological sequelae and complications. Of the 1,165 patients that underwent Emergency Room thoracotomy for cardiac injuries, 363 (31.1%) survived. Only four series described Emergency Room thoracotomy in the pediatric population; 142 children underwent this procedure, 57 of them were due to penetrating injuries, with a survival rate of 12.2%.
Conclusion: Emergency Room thoracotomy is a valuable tool for the Trauma Surgeon, which must be employed judiciously, and under strict indications. Its misuse may increase morbidity and mortality rates. Emergency Room thoracotomy is still the last hope for many patients that arrive in extreme conditions. This procedure must be done by appropriately trained surgeons in the use of this technique.


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