J. L. Fitch1,3,4, S. Dieffenbaugher2, M. McNutt2, C. C. Miller1, D. J. Wainwright2, J. Villarreal1, Q. Zhang1, G. Hall1, S. Gordy1, J. Ward1, C. Wilson1, J. Suliburk1, M. A. Davis1, S. R. Todd1 1Baylor College Of Medicine,General Surgery,Houston, TX, USA 2McGovern Medical School at UTHealth,General Surgery,Houston, TX, USA 3Naval Medical Center Portsmouth,General Surgery,Portsmouth, VA, USA 4Uniformed Services University Of The Health Sciences,General Surgery,Bethesda, MD, USA
Introduction: Survival following traumatic cardiac arrest is low, but resuscitative thoracotomy (RT) is lifesaving for select patients. Data exists on those who are likely to survive RT but is limited regarding hospital course and prognosis following admission to the intensive care unit (ICU). The objective of this study was to describe the hospital course and prognosis for RT survivors admitted to the ICU.
Methods: This was a retrospective review of all adult trauma patients who underwent RT following traumatic arrest at the only two level one trauma centers serving our metropolitan area. Data evaluated include patient demographics, injury characteristics, hospital course, and outcome.
Results: Over 66 months ending June 2017, there were 52,624 trauma activations for both centers. 298 (0.6%) patients underwent RT, and 96 of these (32%) survived to ICU admission. Of these initial survivors, the mean age was 35.8±14.5 years. 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3±13.7. 67% of deaths in the ICU occurred within the first 24 hours of admission. 90% of those alive at day 21 survived to discharge. Of those admitted to the ICU, 22% of blunt and 34% of penetrating patients survived to discharge. The mean ICU length of stay (LOS) for survivors was 24.1±17.9 days, while the mean hospital LOS was 43.9±32.1 days. Survivors averaged 1.9±1.5 complications; most commonly acute kidney injury, deep surgical site infection, and deep vein thrombosis. 24 of 28 patients surviving to discharge went home or to a rehabilitation center.
Conclusion: Survival following RT is 9.4%, but there is an increased likelihood of survival with each day the patient remains alive. Families should be counseled to expect a long hospital course with a high likelihood of complications. The overall prognosis for survivors of RT may not be as bleak as previously assumed.
