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. 2022 Dec;48(6):4631-4638.
doi: 10.1007/s00068-022-01995-y. Epub 2022 May 28.

Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center

Hilaire de Malleray  1 , Michael Cardinale  1 , Jean-Philippe Avaro  2 , Eric Meaudre  1 , Tristan Monchal  3 , Stéphane Bourgouin  3 , Mathieu Vasse  2 , Paul Balandraud  3 , Henri de Lesquen  4
Affiliations

Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center

Hilaire de Malleray et al. Eur J Trauma Emerg Surg. 2022 Dec.

Abstract

Purpose: To investigate survival after emergency department thoracotomy (EDT) in a physician-staffed emergency medicine system.

Methods: This single-center retrospective study included all in extremis trauma patients who underwent EDT between 2013 and 2021 in a military level 1 trauma center. CPR time exceeding 15 minutes for penetrating trauma of 10 minutes for blunt trauma, and identified head injury were the exclusion criteria.

Results: Thirty patients (73% male, 22/30) with a median age of 42 y/o [27-64], who presented mostly with polytrauma (60%, 18/30), blunt trauma (60%, 18/30), and severe chest trauma with a median AIS of 4 3-5 underwent EDT. Mean prehospital time was 58 min (4-73). On admission, the mean ISS was 41 29-50, and 53% (16/30) of patients had lost all signs of life (SOL) before EDT. On initial work-up, Hb was 9.6 g/dL [7.0-11.1], INR was 2.5 [1.7-3.2], pH was 7.0 [6.8-7.1], and lactate level was 11.1 [7.0-13.1] mmol/L. Survival rates at 24 h and 90 days after penetrating versus blunt trauma were 58 and 41% versus 16 and 6%, respectively. If SOL were present initially, these values were 100 and 80% versus 22 and 11%.

Conclusion: Among in extremis patients supported in a physician-staffed emergency medicine system, implementation of a trauma protocol with EDT resulted in overall survival rates of 33% at 24 h and 20% at 90 days. Best survival was observed for penetrating trauma or in the presence of SOL on admission.

Keywords: Aortic occlusion; Thoracotomy; Traumatic cardiac arrest.

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