ORIGINAL ARTICLES
IMAJ | volume 24
Journal 9, September 2022
pages: 570-573
Emergent exploratory thoracotomy with military casualties: contemporary prehospital management and outcome (see editorial page 619)
1Department of Thoracic Surgery, Padeh Medical Center, Poriya, Israel
2Trauma and Combat Medicine Branch, Surgeon General's Headquarters, Israel Defense Forces, Ramat Gan, Israel
3Hospital Management, Meir Medical Center, Kfar Saba, Israel
4Azrieli Faculty of Medicine, Bar-Ilan University, Safed, Israel
5Department of Internal Medicine E, Sheba Medical Center, Tel Hashomer, Israel
6Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel
7Department of Plastic Surgery, Shamir Medical Center, Zriffin, Israel
Summary
Background:
Chest trauma is among the most common types of trauma, corresponding to 10% of trauma patients admitted to hospitals. In the military setting, thoracic trauma was reported as a significant cause of death. With well-timed treatment, chest trauma is regarded as survivable. Emergency thoracotomy (ET) is considered when the patient with trauma to the chest needs immediate resuscitation. Survival rate is reported as low as 1% in some reports and 20% in others. The survival rate depends on injury mechanism, protocols for intervention, and other decompressive procedures.
Objectives:
To determine parameters that may impact survival of ET.
Methods:
We conducted a retrospective cohort study to compare prehospital and in-hospital data regarding ET in the emergency department (ED) versus the operating room (OR).
Results:
Between 2009 and 2017, 6532 casualties presented to the ED; 1125 with trauma to the chest. Fifty-four of those with chest trauma underwent ET in the hospital (4.8%), 22 (41%) in the ED, and 32 (59%) in the OR. The overall mortality of the ET subgroup was 48%. With regard to thoracotomies, 19/22 of patients (86%) who underwent ET in the ED died compared to 2/28 in the OR (13%).
Conclusions:
Utilizing ET after chest trauma with appropriate clinical indications, well-trained personnel, and prompt transportation poses a significant challenge, but may be associated with better survival than that reported previously with military casualties. Adoption of indications and timed allocation to the OR may improve outcomes with chest trauma casualties.