K. Williams1, S. N. Zafar1, Z. Hashmi2, N. Changoor1, S. A. Zafar3, J. Hwabejire1, A. Haider4, E. E. Cornwell1 1Howard University College Of Medicine,Surgery,Washington, DC, USA 2Sinai Hospital,Baltimore, MD, USA 3University Hospital Limerick,Surgery,Limerick, , Ireland 4Brigham And Women’s Hospital,Boston, MA, USA
Introduction: Emergency resuscitative thoracotomy (ERT) is a potentially life-saving procedure that is infrequently performed. Evaluation of its efficacy is controversial and has been limited to bivariate analyses. Studying outcomes from a large national database allows for more robust analytic techniques and a better understanding of its current use in both penetrating and blunt trauma.
Methods: We analyzed the National Trauma Data Bank for the period 2007 to 2012. We selected all patients who underwent an emergency thoracotomy for traumatic arrest (no vital signs after sustaining an injury). Logistic regression analyses were utilized to assess factors associated with survival after ERT. Propensity score matching was used to match patients receiving ERT with similarly injured patients in traumatic arrest that did not undergo ERT. Separate analyses were performed for blunt and penetrating injuries.
Results: Of the 4 million records in the dataset, 31,528 (0.9%) patients presented in traumatic arrest. ERT was performed on 2,223 (7%) patients. The mean age was 30.6 (±20) years, 85% were male, 45% were Black, 25% White and 21% were Hispanic, 55% were uninsured, 75% suffered severe thoracic injuries, 75% arrived via ground ambulance. Penetrating injury occurred in 80% of patients and the overall survival was 2.2%. On multivariate analysis patients more likely to survive were Black compared with White, insured, with stab wounds, severe chest injuries, and those transported by private vehicle versus ground ambulance. After propensity matching, patients with penetrating injuries were 44% more likely to survive if they underwent an ERT (OR = 0.56, 95% CI = 0.38-0.83). However, for blunt injuries there was no survival benefit of ERT (OR= 0.73 95% CI = 0.39-1.36).
Conclusion: Outcomes for ERT among patients with traumatic arrest have been reviewed in a large trauma dataset. Survival among patients presenting with no vital signs is very low and the utility of ERT in this population may need reconsideration especially for blunt injuries.
