Paolo Aseni1, Francesco Rizzetto2, Antonino M Grande3, Roberto Bini4, Fabrizio Sammartano5, Federico Vezzulli6, Maurizio Vertemati7. 1. Department of Emergency, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy; Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy. Electronic address: paolo.aseni@ospedaleniguarda.it. 2. Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy; Department of Radiology, ASST Grande Ospedale Metropolitano Niguarda, Piazza Ospedale Maggiore 3, 20162, Milan, Italy. Electronic address: francesco.rizzetto@unimi.it. 3. Department of Cardiac Surgery, IRCCS Fondazione Policlinico San Matteo Pavia, viale Camillo Golgi 19, 27100, Pavia, Italy. Electronic address: amgrande@libero.it. 4. Trauma Center and Metropolitan Trauma Network Department, Niguarda Hospital, Milan, Italy. Electronic address: roberto.bini@ospedaleniguarda.it. 5. Trauma Center and Metropolitan Trauma Network Department, Niguarda Hospital, Milan, Italy. Electronic address: fabrizio.sammartano@ospedaleniguarda.it. 6. Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy. Electronic address: federico.vezzulli@studenti.unimi.it. 7. Department of Biomedical and Clinical Sciences "L. Sacco", Università degli Studi di Milano, via Giovanni Battista Grassi 74, 20157, Milan, Italy; CIMaINa (Interdisciplinary Centre for Nanostructured Materials and Interfaces), Università degli Studi di Milano, Milan, Italy. Electronic address: maurizio.vertemati@unimi.it.
Abstract
BACKGROUND: Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient's outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries. METHODS: Literature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints. RESULTS: A total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT. CONCLUSIONS: EDRT should be reserved for acute resuscitation of selected dying trauma patient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure.
BACKGROUND: Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient's outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries. METHODS: Literature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints. RESULTS: A total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT. CONCLUSIONS: EDRT should be reserved for acute resuscitation of selected dying traumapatient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure.
Authors: E Ter Avest; L Carenzo; R A Lendrum; M D Christian; R M Lyon; C Coniglio; M Rehn; D J Lockey; Z B Perkins Journal: Crit Care Date: 2022-06-20 Impact factor: 19.334
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