REVIEW OF EMERGENCY THORACOTOMY FOR CHEST INJURIES IN PATIENTS ATTENDING A UK ACCIDENT AND EMERGENCY DEPARTMENT

Over a two and a half year period 25 patients presenting to the Glasgo w Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A&E) department and seven (28 per cent) in a fully equ ipped operating theatre after resuscitation. There were 23 men and 2 w omen. Twenty-three (92 per cent) had been stabbed, one (4 per cent) ha d been shot and one (4 per rent) had sustained a blunt injury in a roa d traffic accident. Eight (32 per cent) patients survived. All survivo rs had been stabbed and seven were well enough to undergo thoracotomy in theatre. Only one (5.6 per cent) of the patients operated upon in t he A&E department survived to discharge, although three (16.8 per cent ) survived the initial procedure. Three of four patients survived, in whom the diagnosis of cardiac tamponade was initially missed. Thirteen (76.5 per cent) of the 17 who did not survive had no vital signs an a dmission. Outcomes may be improved if appropriately trained hospital s taff are immediately available and prehospital delays are minimized so that patients arrive sooner with signs of life still present. Ambulan ce paramedic interventions have little to offer these patients and may worsen the prognosis if they result in delayed transport to hospital. The emphasis placed on diagnosis and treatment of cardiac tamponade i n Advanced Trauma Life Support programmes is appropriate and all staff involved in these cases should undergo this type of training.