Introduction: Emergency department
thoracotomy (EDT), also termed "resuscitative
thoracotomy", is indicated in some cases of life-threatening isolated
thoracic injury, or as a part of
CPR (
cardiopulmonary resuscitation) in
multiple trauma patients, or in thoracic
trauma patients with massive
bleeding (such as intra-abdominal
exsanguination or injury to the great vessels). There is a lack of information in the literature concerning predictors of survival after EDT in patients with predominant or isolated thoracic
trauma. Patients and methods: The study was retrospective and single-center. We collected clinical and laboratory data from all civil and military
trauma patients admitted to our emergency department (ED) with predominant
thoracic injuries who underwent EDT at Soroka Medical Center. A total of 31 patients were included in the study. Results: Of the patients in the study group, 58% presented with penetrating
thoracic injuries and 42% presented with blunt
thoracic injuries. 13 patients (42%) survived the EDT procedure. The following parameters predicted survival after EDT: signs of life and the presence of sinus rhythm on admission to the ED; heart rate at the end of the EDT procedure; short duration of EDT; and total positive balance (fluid and blood products) after EDT. Patients who sustained penetrating
stab wound injuries had a better immediate post-operative survival rate after EDT than those who sustained penetrating
gunshot wounds or predominant blunt chest
trauma (30.8% vs 11.1%; p-0.034). Six patients (19%) survived until discharge from the hospital: 3 with penetrating
injuries and 3 with blunt
thoracic injuries. Conclusion: In patients undergoing EDT after
thoracic injury we found that the clinical status on admission to the ED, the duration of the EDT procedure and the heart rate at the end of procedure were predictors of survival after EDT. We demonstrated a higher survival rate after EDT in patients with predominant penetrating thoracic
trauma.