Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis
Journal of Surgical Research
ED thoracotomy, Prehospital thoracotomy, Thoracic blunt and penetrating, trauma, Field resuscitation, Trauma outcomes
Background: Emergency department resuscitative thoracotomy (ED-RT) or prehospital re- suscitative thoracotomy (PH-RT) is performed for trauma patients with impending or full cardiovascular collapse. This systematic review and meta-analysis analyze outcomes in pa- tients with thoracic trauma receiving PH-RT and ED-RT.
Methods: PubMed, JAMA Network, and CINAHL electronic databases were searched to iden- tify studies published on ED-RT or PH-RT between 2000-2020. Patients were grouped by lo- cation of procedure and type of thoracic injury (blunt versus penetrating).
Results: A total of 49 studies met the criteria for qualitative analysis, and 43 for quantitative analysis. 43 studies evaluated ED-RT and 5 evaluated PH-RT. Time from arrival on scene to PH-RT >5 min was associated with increased neurological complications and time from the initial encounter to PH-RT or ED-RT >10 min was associated with increased mortality. ISS ≥ 25 and absent signs of life were also associated with increased mortality. There was higher mortality in all PH-RT (93.5%) versus all ED-RT (81.8%) (P = 0.02). Among ED-RTs, a significant difference was found in mortality rate between patients with blunt (92.8%) versus penetrating (78.7%) injuries (P < 0.001). When considering only blunt or penetrating injury types, no significant difference in RT mortality rate was found between ED-RT and PH-RT (P = 0.65 and P = 0.95, respectively).
Conclusions: ED-RT and PH-RT are potentially life-saving procedures for patients with pen- etrating thoracic injuries in extremis and with signs of life. The efficacy of this procedure is time sensitive. Moreover, there appears to be a greater mortality risk for patients with thoracic trauma receiving RT in the PH setting compared to the ED setting. More studies are needed to determine the significance of PH-RT mortality.
Liu, Amy; Nguyen, Jackie; Ehrlich, Haley; Bisbee, Charles; Santiesteban, Luis; Santos, Radleigh; McKenney, Mark; and Elkbuli, Adel, "Emergency Resuscitative Thoracotomy for Civilian Thoracic Trauma in the Field and Emergency Department Settings: A Systematic Review and Meta-Analysis" (2022). Mathematics Faculty Articles. 343.