Jared Scott, MD, a contributor with a wealth of knowledge in emergency medicine, dives into the high-stakes world of immediate resuscitative thoracotomy. He discusses how this urgent procedure can be a lifesaver in traumatic cardiac arrest cases. The conversation highlights the crucial criteria for performing the surgery, particularly in cases like a young woman struck by a car. Scott also shares impactful findings on survival rates from recent studies, emphasizing the importance of timely medical intervention in trauma care.
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Trauma Case
A young woman, hit by a car and dragged, arrived in the ED with signs of life.
Despite receiving a thoracotomy, the outcome was not favorable.
volunteer_activism ADVICE
Thoracotomy Criteria
Perform immediate ED thoracotomy if trauma patients meet specific criteria based on the type of trauma and duration of CPR.
Prioritize thoracotomy over other interventions like additional lines or warm blankets, unless there's a strong medical reason.
insights INSIGHT
Thoracotomy Outcomes
A large study showed a 20% survival rate for patients receiving ED thoracotomy within 60 minutes of arrival.
Penetrating trauma had a 26% survival rate, while blunt trauma had only 7%.
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Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest
Western Trauma Association Society Criteria for ED thoracotomy
Blunt trauma +
Penetrating trauma to torso +
Penetrating trauma to the neck/extremity +
Signs of life with refractory shock can consider resuscitative thoracotomy
Outcomes in immediate resuscitative thoracotomy are poor but are improving
A recent study evaluated over 2,000 patients meeting inclusion criteria for immediate resuscitative thoracotomy
Overall survival rate of 20%
26% survival rate in penetrating trauma
7% survival rate in blunt trauma
Predictors for poor outcomes
Patient age > 60 years
Blunt trauma mechanism of injury
A prehospital or ED HR
Absent signs of life at time of ED arrival
When criteria are met, immediate resuscitative thoracotomy should rapidly be performed in the ED
References
Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363.
Panossian VS, Nederpelt CJ, El Hechi MW, et al. Emergency Resuscitative Thoracotomy: A Nationwide Analysis of Outcomes and Predictors of Futility. J Surg Res. 2020;255:486-494.
Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD
In an effort to promote diversity, equity, and inclusion in Emergency Medicine, The Emergency Medical Minute is proud to present our 2nd annual Diversity and Inclusion Award. We support increasing the representation of underrepresented groups in medicine and extend this award to individuals applying to emergency medicine residencies during the 2022-2023 cycle. For information on award eligibility and the application process, visit https://emergencymedicalminute.com/edi-award/
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