1887
Volume 2022, Issue 2
  • ISSN: 1999-7086
  • EISSN: 1999-7094

Abstract

Emergency thoracotomy is a potentially life-saving maneuver for trauma patients in extremis. Since trauma scenarios, in rural locations, usually occur with a high incidence of a severe injury that leads to hemorrhagic shock or cardiopulmonary arrest. The objective of this study was to analyze the experience in emergency thoracotomy performed by a general surgeon in a rural area in Thailand. This retrospective study was conducted by analyzing the patient records including demographics, mechanisms of injuries, specific organ injury, surgical approach, life-saving surgical procedure, and postoperative outcome for all patients who underwent emergency thoracotomy in the Department of Surgery, Srinakharinwirot University hospital between January 2010 and December 2020. Twelve patients underwent emergency thoracotomy within 1 hour after arrival and were equally divided between blunt and penetrating injuries with 6 (50%). A mean patient age of 34.8 ± 15.2 years (range 16–55), mean systolic blood pressure on arrival was 65.8 ± 35.2 mmHg (range 0–100 mmHg), and the mean injury severity score (ISS) was 54.6 ± 25.2 (range 26–75). Profound hemorrhagic shock is a major indication for emergency thoracotomy. The overall survival rate was 41.7% (5/12 patients) without survivors from cardiac injuries. Four patients (66.7%) in the penetrating and 1 patient (16.7%) in the blunt intrathoracic injury group were survived and discharged from the hospital. Emergency thoracotomy offers a chance for survival at 41.7% for trauma patients who present with extremes in this study. Rapid decision-making, good operative technique, and adequate patient selection are crucial for reasonable outcomes.

Loading

Article metrics loading...

/content/journals/10.5339/jemtac.2022.7
2022-01-20
2022-10-05
Loading full text...

Full text loading...

/deliver/fulltext/jemtac/2022/2/jemtac.2022.7.html?itemId=/content/journals/10.5339/jemtac.2022.7&mimeType=html&fmt=ahah

References

  1. Edens JW, Beekley AC, Chung KK, et al. Longterm outcomes after combat casualty emergency department thoracotomy. J Am Coll Surg. 2009; 209:(2):188–197.
    [Google Scholar]
  2. Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015; 79:(1):159–173.
    [Google Scholar]
  3. Lorenz HP, Steinmetz B, Lieberman J, Schecoter WP, Macho JR. Emergency thoracotomy: survival correlates with physiologic status. J Trauma. 1992; 32:(6):780–5.
    [Google Scholar]
  4. Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000; 190:(3):288–298.
    [Google Scholar]
  5. Refaely Y, Koyfman L, Friger M, et al. Clinical Outcome of Urgent Thoracotomy in Patients with Penetrating and Blunt Chest Trauma: A Retrospective Survey. Thorac Cardiovasc Surg. 2018; 66:(8):686–692.
    [Google Scholar]
  6. Duchesne JC, Hunt JP, Marr AB. M. Rural Trauma. In: Feliciano DV, Mattox KL, Moore EE. Editors. Trauma. 9th ed. New York, NY: McGraw Hill; 2021: 171–188.
    [Google Scholar]
  7. Dickson RL, Gleisberg G, Aiken M, et al. Emergency Medical Services Simple Thoracostomy for Traumatic Cardiac Arrest: Postimplementation Experience in a Ground-based Suburban/Rural Emergency Medical Services Agency. J Emerg Med. 2018; 55:(3):366–371.
    [Google Scholar]
  8. Chadbunchachai W, Suphanchaimaj W, Settasatien A, Jinwong T. Road traffic injuries in Thailand: current situation. J Med Assoc Thai. 2012; 95: Suppl 7:S274–S281.
    [Google Scholar]
  9. Wikipedia. List of motor vehicle deaths in Thailand by year. Website. Available from: https://en.wikipedia.org/wiki/List_of_motor_vehicle_deaths_in_Thailand_by_year. Access Aug 24, 2021.].
    [Google Scholar]
  10. Mancini A, Bonne A, Pirvu A, et al. Retrospective study of thoracotomy performed in a French level 1-trauma center. J Visc Surg. 2017; 154:(6):401–406.
    [Google Scholar]
  11. Flaris AN, Simms ER, Prat N, Reynard F, Caillot JL, Voiglio EJ. Clamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited. World J Surg. 2015; 39:(5):1306–1311.
    [Google Scholar]
  12. Newberry R, Brown D, Mitchell T, et al. Prospective Randomized Trial of Standard Left Anterolateral Thoracotomy Versus Modified Bilateral Clamshell Thoracotomy Performed by Emergency Physicians. Ann Emerg Med. 2021; 77:(3):317–326.
    [Google Scholar]
  13. Flaris AN, Simms ER, Prat N, Reynard F, Caillot JL, Voiglio EJ. Clamshell incision versus left anterolateral thoracotomy. Which one is faster when performing a resuscitative thoracotomy? The tortoise and the hare revisited. World J Surg. 2015; 39:(5):1306–1311.
    [Google Scholar]
  14. Newberry R, Brown D, Mitchell T, et al. Prospective Randomized Trial of Standard Left Anterolateral Thoracotomy Versus Modified Bilateral Clamshell Thoracotomy Performed by Emergency Physicians. Ann Emerg Med. 2021; 77:(3):317–326.
    [Google Scholar]
http://instance.metastore.ingenta.com/content/journals/10.5339/jemtac.2022.7
Loading
/content/journals/10.5339/jemtac.2022.7
Loading

Data & Media loading...

Most Cited This Month Most Cited RSS feed

This is a required field
Please enter a valid email address
Approval was a Success
Invalid data
An Error Occurred
Approval was partially successful, following selected items could not be processed due to error