BACKGROUND: The evidence for resuscitative thoracotomy (RT) in trauma patients following wartime injury is limited; its indications and timings are less defined in battle injury. The aim of this study was to analyze survival as well as the causes and times of death in patients undergoing RT within the context of modern battlefield resuscitation. METHODS: A retrospective cohort study was performed on consecutive admissions to a Field Hospital in Southern Afghanistan. All patients undergoing RT were identified using the UK Joint Theatre Trauma Registry. The primary outcome was 30-day mortality, and secondary outcomes included location of cardiac arrest, time from arrest to thoracotomy, and proportion achieving a return of spontaneous circulation. RESULTS: Between April 2006 to March 2011, 65 patients underwent RT with 14 survivors (21.5%). Ten patients (15.4%) had an arrest in the field with no survivors, 29 (44.6%) had an arrest en route with 3 survivors, and 26 (40.0%) had an arrest in the emergency department with 11 survivors. There was no difference in Injury Severity Scores (ISSs) between survivors and fatalities (27.3 [7.6] vs. 36.0 [22.1], p = 0.636). Survivors had a significantly shorter time to thoracotomy than did fatalities (6.15 [5.8] minutes vs. 17.7 [12.63] minutes, p < 0.001). CONCLUSION: RT following combat injury will yield survivors. Best outcomes are in patients who have an arrest in the emergency department or on admission to the hospital. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.
BACKGROUND: The evidence for resuscitative thoracotomy (RT) in traumapatients following wartime injury is limited; its indications and timings are less defined in battle injury. The aim of this study was to analyze survival as well as the causes and times of death in patients undergoing RT within the context of modern battlefield resuscitation. METHODS: A retrospective cohort study was performed on consecutive admissions to a Field Hospital in Southern Afghanistan. All patients undergoing RT were identified using the UK Joint Theatre Trauma Registry. The primary outcome was 30-day mortality, and secondary outcomes included location of cardiac arrest, time from arrest to thoracotomy, and proportion achieving a return of spontaneous circulation. RESULTS: Between April 2006 to March 2011, 65 patients underwent RT with 14 survivors (21.5%). Ten patients (15.4%) had an arrest in the field with no survivors, 29 (44.6%) had an arrest en route with 3 survivors, and 26 (40.0%) had an arrest in the emergency department with 11 survivors. There was no difference in Injury Severity Scores (ISSs) between survivors and fatalities (27.3 [7.6] vs. 36.0 [22.1], p = 0.636). Survivors had a significantly shorter time to thoracotomy than did fatalities (6.15 [5.8] minutes vs. 17.7 [12.63] minutes, p < 0.001). CONCLUSION: RT following combat injury will yield survivors. Best outcomes are in patients who have an arrest in the emergency department or on admission to the hospital. LEVEL OF EVIDENCE: Epidemiologic/prognostic study, level III.
Authors: David P Stonko; Joseph Edwards; Hossam Abdou; Noha N Elansary; Eric Lang; Samuel G Savidge; Caitlin W Hicks; Jonathan J Morrison Journal: Front Physiol Date: 2022-05-09 Impact factor: 4.755
Authors: Zirun Zhao; Justine J Liang; Zhe Wang; Nathan J Winans; Matthew Morris; Stephen Doyle; Adam Fry; Susan M Fiore; Sima Mofakham; Charles B Mikell Journal: Trauma Surg Acute Care Open Date: 2021-02-11
Authors: Daniel Ohlén; Magnus Hedberg; Paula Martinsson; Erik von Oelreich; Therese Djärv; Malin Jonsson Fagerlund Journal: Scand J Trauma Resusc Emerg Med Date: 2022-10-17 Impact factor: 3.803