HOMEPRODUCTSCOMPANYCONTACTFAQResearchDictionaryPharmaSign Up FREE or Login

Emergency department thoracotomy: still useful after abdominal exsanguination?

AbstractBACKGROUND:
Although literature regarding emergency department thoracotomy (EDT) outcome after abdominal exsanguination is limited, numerous reports have documented poor EDT survival in patients with anatomic injuries other than cardiac wounds. As a result, many trauma surgeons consider prelaparotomy EDT futile for patients dying from intra-abdominal hemorrhage. Our primary study objective was to prove that prelaparotomy EDT is beneficial to patients with exsanguinating abdominal hemorrhage.
METHODS:
A retrospective review of 237 consecutive EDTs for penetrating injury (2000-2006) revealed 50 patients who underwent EDT for abdominal exsanguination. Age, gender, injury mechanism and location, field and emergency department (ED) signs of life, prehospital time, initial ED cardiac rhythm, vital signs, Glasgow Coma Score, blood transfusion requirements, predicted mortality, primary abdominal injuries, and the need for temporary abdominal closure were analyzed. The primary study endpoint was neurologically intact hospital survival.
RESULTS:
The 50 patients who underwent prelaparotomy EDT for abdominal exsanguination were largely young (mean, 27.3 +/- 8.2 years) males (94%) suffering firearm injuries (98%). Patients presented with field (84%) and ED signs of life (78%) after a mean prehospital time of 21.2 +/- 9.8 minutes. Initial ED cardiac rhythms were variable and Glasgow Coma Score was depressed (mean, 4.2 +/- 3.2). Eight (16%) patients survived hospitalization, neurologically intact. Of these eight, all were in hemorrhagic shock because of major abdominal vascular (75%) or severe liver injuries (25%) and all required massive blood transfusion (mean, 28.6 +/- 17.3 units) and extended intensive care unit length of stay (mean, 36.3 +/- 25.7 days).
CONCLUSIONS:
Despite critical injuries, 16% survived hospitalization, neurologically intact, after EDT for abdominal exsanguination. Our results suggest that prelaparotomy EDT provides survival benefit to penetrating trauma victims dying from intra-abdominal hemorrhage.
AuthorsMark J Seamon, Abhijit S Pathak, Kevin M Bradley, Carol A Fisher, John A Gaughan, Heather Kulp, Paola G Pieri, Thomas A Santora, Amy J Goldberg
JournalThe Journal of trauma (J Trauma) Vol. 64 Issue 1 Pg. 1-7; discussion 7-8 (Jan 2008) ISSN: 1529-8809 [Electronic] United States
PMID18188091 (Publication Type: Comparative Study, Journal Article)
Topics
  • Abdominal Injuries (mortality, surgery)
  • Adult
  • Female
  • Hemorrhage (surgery)
  • Humans
  • Male
  • Retrospective Studies
  • Shock, Hemorrhagic (surgery)
  • Thoracic Injuries (surgery)
  • Thoracotomy
  • Trauma Centers
  • Wounds, Penetrating (mortality, surgery)

Join CureHunter, for free Research Interface BASIC access!

Take advantage of free CureHunter research engine access to explore the best drug and treatment options for any disease. Find out why thousands of doctors, pharma researchers and patient activists around the world use CureHunter every day.
Realize the full power of the drug-disease research graph!


Choose Username:
Email:
Password:
Verify Password:
Enter Code Shown: