Emergency thoracotomy: Experience of one year in a large tertiary trauma center

AbstractIntroductionEmergency thoracotomy (ET) can be a life-saving procedure in highly selected trauma patients, especially after penetrating chest trauma. The aim of this work was to evaluate the outcome in trauma patients who were admitted to the Alexandria Main University Hospital (AMUH) during 1 year period and underwent ET as a management and to compare our results with that documented in the literature.Patients and methodsThis is prospective clinical study included trauma patients who were admitted to AMUH during 1 year period (August 2013–August 2014) and underwent ET. Analysis of the cause of trauma, age, sex, different tools of investigations used, concomitant organ injuries, systolic blood pressure (SBP), Glasgow Coma Scale (GCS), Injury Severity Score (ISS), Trauma Revised Injury Severity Score (TRISS) and mortality rate were performed.ResultsTwenty-two patients who had ET were included in this study (All were males, Age range: 5–45 years; median: 23.5 ± 7.83 years). Twenty patients from twenty-two were survived. Two of them had blunt trauma while 18 had penetrating injuries. The most frequent injury encountered was isolated thoracic injury (n=13). Thoracotomy was performed in 20 patients, sternotomy in two, and one patient underwent additional laparotomy. Median ISS and TRISS were 10 (Range 9–29) and 0.98 (Range 0.54–0.99), respectively. Blood transfusion ranged between 1 and 13 units with a median of 2 units of packed red blood cells. The median time from admission to operating room was 37.50 min. Pre-operative (FAST & Thoracic Ultrasound) was done in 90.9% of patients. Most common indication for thoracotomy was shock (SBP < 90). The mortality rate was 9.1% for all patients and 10% for patients with penetrating trauma. Factors affecting mortality was ISS and the amount of blood transfusion.ConclusionET procedure is an important tool in management of selected trauma patients. Rapid assessment, multidisciplinary approach, good resuscitation and prompt surgical intervention reduce the mortality and improve the outcome