PENETRATING CHEAT TRAUMA - SHOULD INDICATIONS FOR EMERGENCY ROOM THORACOTOMY BE LIMITED

A total of 160 patients underwent emergency room thoracotomy (ERT) fro m January 1988 to June 1995. There were 142 male and 18 female patient s with ages ranging from 15 months to 72 years old with a mean age of 31 years. Blunt trauma was the mechanism of injury in 11 patients; non e of them survived, and they were excluded from further analysis. A to tal of 149 patients sustained penetrating trauma, 111 patients gunshot wounds, and 38 patients stab wounds. A total of four patients survive d to discharge for an overall survival rate of 2.7 per cent. All four were victims of a stab wound and were neurologically intact at the tim e of discharge. Special interest was placed in classifying patients ac cording to their physiologic status both at the scene and on arrival t o the emergency department. Class I, patients with no signs of life; C lass II, Agonal-patients in electromechanical dissociation/pulseless e lectrical activity with no palpable pulse or blood pressure; Class III , Profound Shock-patients with blood pressure less than 60 mm Hg, and Class IV, Mild Shock-patients with blood pressure between 60 and 90 mm Hg. 122 patients (89%) fitted the criteria for Scene Classes I and II . None of these patients improved or responded to prehospital resuscit ation to be moved up to Emergency Department Classes III or IV, and al l of them died. Of the four survivors, three were in Scene Class III a nd one was in Scene Class IV. This study confirms a previous report th at, overall, ERT has a very low survival rate. ERT should be abandoned in patients sustaining: blunt trauma, and should probably be limited to patients sustaining penetrating chest injuries who fall into the ph ysiologic Classes III or IV at the scene.