Emergency room thoracotomy for penetrating chest injury: Effect of an institutional protocol

Background: Emergency room thoracotomy (ERT) can be life saving in patients with penetrating chest injury. A protocol was established at our instituti on stating that ERT be performed for cases of cardiac tamponade secondary t o penetrating chest trauma on patients with vital signs/mentation in the fi eld or on arrival to the emergency room, To validate our protocol, we reeva luated patients undergoing ERT at our institution, Methods: In our retrospective review, there were 49 patients undergoing ERT over a 6-year period. Results: Survival in patients with vital signs was approximately 50%, Survi val in those without was 0%. Compared with the preprotocol data, the number of ERTs declined from 32.2 cases per year to 8.1 cases per gear. Overall s urvival increased from 4% to 20%, Neurologic outcome remained unchanged. Conclusion: We believe that the data validate our protocol, and the establi shment of a guideline has enabled us to maximize patient survival and minim ize exposure risks to our staff.