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26.12.2018 | Original Article | Ausgabe 1/2019 Open Access

Updates in Surgery 1/2019

Outcomes and indications for emergency thoracotomy after adoption of a more liberal policy in a western European level 1 trauma centre: 8-year experience

Zeitschrift:
Updates in Surgery > Ausgabe 1/2019
Autoren:
Edoardo Segalini, Luca Di Donato, Arianna Birindelli, Alice Piccinini, Alberto Casati, Carlo Coniglio, Salomone Di Saverio, Gregorio Tugnoli, Bologna Trauma Team collaborative group
Wichtige Hinweise

Electronic supplementary material

The online version of this article (https://​doi.​org/​10.​1007/​s13304-018-0607-4) contains supplementary material, which is available to authorized users.
The technique described and the preliminary results of the present study have been presented in partial form at the ESTES Congress 2016 in Vienna on April 24th, 2016.
The members of the Bologna Trauma Team collaborative group have given in Acknowledgements section.

Abstract

The role of emergency thoracotomy (ET) in blunt trauma is still a matter of debate and in Europe only a small number of studies have been published. We report our experience about ET both in penetrating and blunt trauma, discussing indications, outcomes and proposing an algorithm for patient selection. We retrospectively analysed patients who underwent ET at Maggiore Hospital Trauma Center over two periods: from January 1st, 2010 to December 31st, 2012, and from January 1st, 2013 to May 31st, 2017. Demographic and clinical data, mechanism of injury, Injury Severity Score, site of injury, time of witnessed cardiac arrest, presence/absence of signs of life, length of stay were considered, as well as survival rate and neurological outcome. 27 ETs were performed: 21 after blunt trauma and 6 after penetrating trauma. Motor vehicle accident was the main mechanism of injury, followed by fall from height. The mean age was 40.5 years and the median Injury Severity Score was of 40. The most frequent injury was cardiac tamponade. The overall survival rate was 10% during the first period and 23.5% during the second period, after the adoption of a more liberal policy. No long-term neurological sequelae were reported. The outcomes of ET in trauma patient, either after penetrating or blunt trauma, are poor but not negligible. To date, only small series of ET from European trauma centres have been published, although larger series are available from USA and South Africa. However, in selected patients, all efforts must be made for the patient’s survival; the possibility of organ donation should be taken into consideration as well.

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Zusatzmaterial
During the ET, many manoeuvres should be performed, such as opening the pericardium or aortic cross-clamping (JPEG 3385 kb)
13304_2018_607_MOESM3_ESM.jpg
Twisting of the pulmonary hilum for controlling massive hilar injuries (JPEG 2510 kb)
13304_2018_607_MOESM4_ESM.jpg
A clamshell incision is performed at 4°–5° intercostal space, below nipple in males and in the infra-mammary crease in females (JPEG 2084 kb)
13304_2018_607_MOESM5_ESM.jpg
Clamshell thoracotomy provides a better exposition of the thoracicorgans and vessels (JPEG 2591 kb)
13304_2018_607_MOESM6_ESM.jpg
Outcome before discharge on POD 30 (JPEG 245 kb)
13304_2018_607_MOESM7_ESM.jpg
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