1. Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center.
- Author
-
de Malleray, Hilaire, Cardinale, Michael, Avaro, Jean-Philippe, Meaudre, Eric, Monchal, Tristan, Bourgouin, Stéphane, Vasse, Mathieu, Balandraud, Paul, and de Lesquen, Henri
- Subjects
TRAUMA surgery ,HOSPITAL emergency services ,TRAUMA centers ,THORACOTOMY ,RETROSPECTIVE studies ,DESCRIPTIVE statistics - 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. [ABSTRACT FROM AUTHOR]
- Published
- 2022
- Full Text
- View/download PDF