PREDICTORS OF OUTCOME IN PATIENTS WHO HAVE SUSTAINED TRAUMA AND WHO UNDERGO EMERGENCY THORACOTOMY

Objective: To reassess the use of emergency thoracotomy in resuscitati ng victims of abdominal or thoracic trauma. Design: Retrospective revi ew of records and autopsy reports of patients who underwent an emergen cy thoracotomy between 1983 and 1989. Setting: Washington Hospital Cen ter's Level I trauma center. Patients: Two hundred eighty-four hemodyn amically unstable trauma patients (212 [75%] with penetrating injuries and 72 [25%] with blunt injuries). Intervention: Emergency thoracotom y performed in the trauma operating room or in one of the trauma bays. Main Outcome Measures and Key Findings: In which subset of trauma pat ients is emergency thoracotomy a useful therapeutic modality? Performa nce of an emergency thoracotomy for blunt trauma resulted in an overal l survival rate of 6% compared with 27% for penetrating trauma. The su rvival rate for patients with penetrating cardiac trauma was 32% (44% for stab wounds and 21% for gunshot wounds). Tamponade is a major fact or associated with survival in this subset of patients and may act as a pathophysiologic filter. Conclusions: Emergency thoracotomy is a use ful therapeutic modality for victims of penetrating trauma who have vi tal signs on admission to the hospital, and it should be considered in blunt trauma patients who present with any evidence of life. This mod ality is largely ineffective, however, in resuscitating victims of pen etrating and blunt trauma who present to the hospital without vital si gns.