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ED Thoracotomy

ED Thoracotomy. Susan A. O’Malley, MD April 22, 2003. ED Thoracotomy. Absence or presence of vital signs field ED Outcome: survived, neuro intact MOI Anatomic location.

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ED Thoracotomy

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  1. ED Thoracotomy Susan A. O’Malley, MD April 22, 2003

  2. ED Thoracotomy • Absence or presence of vital signs • field • ED • Outcome: survived, neuro intact • MOI • Anatomic location Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 1998;45:87-94

  3. ED Thoracotomy • Retrospective study • 950 EDT over 23 years • Complete records n=868 • 82 unavailable – no survivors (medical examiner records) • Overall survival 4.4% • Functionally intact 3.9% (n=34) Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 1998;45:87-94

  4. ED Thoracotomy • Blunt 45% • GSW 38% • SW 17% Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 1998;45:87-94

  5. EDT survival based on MOI

  6. Field +/- VSneurologically intact

  7. ED +/- VSneurologically intact

  8. Site & MOI neuro intact

  9. MOI & Specific Injury • SW heart 14.6% • SW tamponade 28.6% • GSW heart 1.8% • GSW tamponade 0% • GSW abd 12.1% • cross clamp aorta Critical analysis of two decades of experience with postinjury emergency department thoracotomy in a regional trauma center. J Trauma 1998;45:87-94

  10. Conclusions • Blunt with VS  EDT • Blunt without VS • No electrical activity on EKG  terminate efforts • With electrical activity on EKG  EDT • Penetrating with VS  EDT • Penetrating without VS • No electrical activity on EKG but thoracic injury  EDT • No electrical activity on EKG, NO thoracic injury  terminate • With electrical activity on EKG  EDT

  11. 2001 ACS GuidelinesPractice Management Guidelines for EDT. J Am Coll Surg 2001;193(3):303-309 • 8158 EDT references 1966-1999 • 146 series EDT general trauma • 137 series EDT cardiac injuries • 92 selected based on criteria • Total n, MOI, clearly reported survival, mortality rates, rates stratified by MOI • 42 EDT general trauma • 46 EDT cardiac • 4 EDT pediatric

  12. EDT general trauma • 7,035 EDT, 551 survivors 7.8% • Stratification based on MOI

  13. EDT penetrating cardiac injury • 1,165 • 363 survived • Survival rate 31.1%

  14. Series reporting neuro outcome • 14 series • 4,520 EDT • 226 survivors • 5% survival rate • 34 survived neuro intact • 15% of survivors, 0.07% of EDT

  15. Pediatric EDT • 4 series • 142 EDT • 9 survived • Survival rate 6.3% • Penetrating 12.2% • Blunt 2.3%

  16. 2001 ACS Guidelines • No Class I evidence, no level I recommendations • Level II recs: • Blunt if VS on arrival; witnessed arrest • Penetrating cardiac with short scene and transport time with current or witnessed signs of life • Penetrating noncardiothoracic injuries • Exsanguinating abdominal vascular injuries • Same recs for peds

  17. HUP ism

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