Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress 2023 EHA Congress 2023 ASCO Annual Meeting
Clinical Collections
Advances in Alzheimer’s

At a glance: The ONWARDS insulin icodec trials

A round-up of the ONWARDS phase 3 clinical trials evaluating the novel weekly insulin icodec in people with diabetes.
ADVANCED SEARCH
Log in
Top
European Journal of Trauma and Emergency Surgery
Published in: European Journal of Trauma and Emergency Surgery 5/2012

Open Access 01-10-2012 | Original Article

Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center

Authors: O. J. F. Van Waes, P. A. Van Riet, E. M. M. Van Lieshout, D. D. Hartog

Published in: European Journal of Trauma and Emergency Surgery | Issue 5/2012

Login to get access

Abstract

Background

An emergency department thoracotomy (EDT) or an emergency thoracotomy (ET) in the operating theater are both beneficial in selected patients following thoracic penetrating injuries. Since outcome-descriptive European studies are lacking, the aim of this retrospective study was to evaluate ten years of experience at a Dutch level I trauma center.

Method

Data on patients who underwent an immediate thoracotomy after sustaining a penetrating thoracic injury between October 2000 and January 2011 were collected from the trauma registry and hospital files. Descriptive and univariate analyses were performed.

Results

Among 56 patients, 12 underwent an EDT and 44 an ET. Forty-six patients sustained one or multiple stab wounds, versus ten with one or multiple gunshot wounds. Patients who had undergone an EDT had a lower GCS (p < 0.001), lower pre-hospital RTS and hospital triage RTS (p < 0.001 and p = 0.009, respectively), and a lower SBP (p = 0.038). A witnessed loss of signs of life generally occurred in EDT patients and was accompanied by 100 % mortality. Survival following EDT was 25 %, which was significantly lower than in the ET group (75 %; p = 0.002). Survivors had lower ISS (p = 0.011), lower rates of pre-hospital (p = 0.031) and hospital (p = 0.003) hemodynamic instability, and a lower prevalence of concomitant abdominal injury (p = 0.002).

Conclusion

The overall survival rate in our study was 64 %. The outcome of immediate thoracotomy performed in this level I trauma center was similar to those obtained in high-incidence regions like the US and South Africa. This suggests that trauma units where immediate thoracotomies are not part of the daily routine can achieve similar results, if properly trained.
Literature
1.
MacKenzie EJ. Epidemiology of injuries: current trends and future challenges. Epidemiol Rev. 2000;22(1):112–9.PubMedCrossRef
2.
LoCicero J 3rd, Mattox KL. Epidemiology of chest trauma. Surg Clin North Am. 1989;69(1):15–9.PubMed
3.
Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg. 2001;193(3):303–9.
4.
Baxter BT, Moore EE, Moore JB, Cleveland HC, McCroskey BL, Moore FA. Emergency department thoracotomy following injury: critical determinants for patient salvage. World J Surg. 1988;12(5):671–5.PubMedCrossRef
5.
Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190(3):288–98.PubMedCrossRef
6.
Karmy-Jones R, Nathens A, Jurkovich GJ, Shatz DV, Brundage S, Wall MJ Jr, Engelhardt S, Hoyt DB, Holcroft J, Knudson MM, Michaels A, Long W. Urgent and emergent thoracotomy for penetrating chest trauma. J Trauma. 2004;56(3):664–8. (discussion 668–669).PubMedCrossRef
7.
Miglietta MA, Robb TV, Eachempati SR, Porter BO, Cherry R, Brause J, Barie PS. Current opinion regarding indications for emergency department thoracotomy. J Trauma. 2001;51(4):670–6.PubMedCrossRef
8.
Brown SE, Gomez GA, Jacobson LE, Scherer T 3rd, McMillan RA. Penetrating chest trauma: should indications for emergency room thoracotomy be limited? Am Surg. 1996;62(7):530–3. (discussion 533–534).
9.
Durham LA 3rd, Richardson RJ, Wall MJ Jr, Pepe PE, Mattox KL. Emergency center thoracotomy: impact of prehospital resuscitation. J Trauma. 1992;32(6):775–9.PubMedCrossRef
10.
Bruinsma MY, Moors JA. Illegale vuurwapens. gebruik, bezit en handel in Nederland 2001–2003, IV A Beleidsonderzoek en advies & Ministerie van justitie/WODC, Tilburg en Den Haag; 2005.
11.
Asensio JA, Hanpeter D, Demetriades D. The futility of the liberal utilization of emergency department thoracotomy. A prospective study. In: Proceedings of the american association for the surgery of trauma 58th annual meeting. Baltimore, Maryland; 1998.
12.
Asensio JA, Murray J, Demetriades D, Berne J, Cornwell E, Velmahos G, Gomez H, Berne TV. Penetrating cardiac injuries: a prospective study of variables predicting outcomes. J Am Coll Surg. 1998;186(1):24–34.PubMedCrossRef
13.
Asensio JA, Berne JD, Demetriades D, Chan L, Murray J, Falabella A, Gomez H, Chahwan S, Velmahos G, Cornwell EE, Belzberg H, Shoemaker W, Berne TV. One hundred five penetrating cardiac injuries: a 2-year prospective evaluation. J Trauma. 1998;44(6):1073–82.PubMedCrossRef
14.
Soreide K, Petrone P, Asensio JA. Emergency thoracotomy in trauma: rationale, risks, and realities. Scand J Surg. 2007;96(1):4–10.PubMed
15.
Soreide K, Soiland H, Lossius HM, Vetrhus M, Soreide JA, Soreide E. Resuscitative emergency thoracotomy in a Scandinavian trauma hospital—is it justified? Injury. 2007;38(1):34–42.PubMedCrossRef
16.
Hunt PA, Greaves I, Owens WA. Emergency thoracotomy in thoracic trauma—a review. Injury. 2006;37(1):1–19.
17.
Beall AC Jr, Diethrich EB, Crawford HW, Cooley DA, De Bakey ME. Surgical management of penetrating cardiac injuries. Am J Surg. 1966;112(5):686–92.PubMedCrossRef
18.
Grove CA, Lemmon G, Anderson G, McCarthy M. Emergency thoracotomy: appropriate use in the resuscitation of trauma patients. Am Surg. 2002;68(4):313–6. (discussion 316–317).PubMed
19.
Trauma ACoSCo. Advanced trauma life support for doctors. 8th ed. American College of Surgeons: Chicago; 2008.
20.
Baker SP, O’Neill B, Haddon W Jr, Long WB. The injury severity score: a method for describing patients with multiple injuries and evaluating emergency care. J Trauma. 1974;14(3):187–96.PubMedCrossRef
21.
Champion HR, Sacco WJ, Copes WS, Gann DS, Gennarelli TA, Flanagan ME. A revision of the trauma score. J Trauma. 1989;29(5):623–9.PubMedCrossRef
22.
Garthe E, States JD, Mango NK. Abbreviated injury scale unification: the case for a unified injury system for global use. J Trauma. 1999;47(2):309–23.PubMedCrossRef
23.
Handley AJ, Koster R, Monsieurs K, Perkins GD, Davies S, Bossaert L. European Resuscitation Council guidelines for resuscitation 2005. Section 2. Adult basic life support and use of automated external defibrillators. Resuscitation. 2005;67(Suppl 1):S7–23.PubMedCrossRef
24.
Gomez G, Fecher A, Joy T, Pardo I, Jacobson L, Kemp H. Optimizing outcomes in emergency room thoracotomy: a 20-year experience in an urban level I trauma center. Am Surg. 2010;76(4):406–10.
25.
26.
Henderson VJ, Smith RS, Fry WR, Morabito D, Peskin GW, Barkan H, Organ CH Jr. Cardiac injuries: analysis of an unselected series of 251 cases. J Trauma. 1994;36(3):341–8.PubMedCrossRef
27.
28.
Athanasiou T, Krasopoulos G, Nambiar P, Coats T, Petrou M, Magee P, Uppal R. Emergency thoracotomy in the pre-hospital setting: a procedure requiring clarification. Eur J Cardiothorac Surg. 2004;26(2):377–86.PubMedCrossRef
29.
Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4.PubMedCrossRef
30.
Bleetman A, Kasem H, Crawford R. Review of emergency thoracotomy for chest injuries in patients attending a UK accident and emergency department. Injury. 1996;27(2):129–32.PubMedCrossRef
31.
Onat S, Ulku R, Avci A, Ates G, Ozcelik C. Urgent thoracotomy for penetrating chest trauma: analysis of 158 patients of a single center. Injury. 2010;41(7):876–80.
32.
Seamon MJ, Fisher CA, Gaughan JP, Kulp H, Dempsey DT, Goldberg AJ. Emergency department thoracotomy: survival of the least expected. World J Surg. 2008;32(4):604–12.PubMedCrossRef
33.
Lorenz HP, Steinmetz B, Lieberman J, Schecoter WP, Macho JR. Emergency thoracotomy: survival correlates with physiologic status. J Trauma. 1992;32(6):780–5. (discussion 785–788).PubMedCrossRef
34.
Moore EE, Knudson MM, Burlew CC, Inaba K, Dicker RA, Biffl WL, Malhotra AK, Schreiber MA, Browder TD, Coimbra R, Gonzalez EA, Meredith JW, Livingston DH, Kaups KL. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011;70(2):334–9.
35.
Hall BL, Buchman TG. A visual, timeline-based display of evidence for emergency thoracotomy. J Trauma. 2005;59(3):773–7.PubMed
36.
Coats TJ, Keogh S, Clark H, Neal M. Prehospital resuscitative thoracotomy for cardiac arrest after penetrating trauma: rationale and case series. J Trauma. 2001;50(4):670–3.PubMedCrossRef
37.
Mejia JC, Stewart RM, Cohn SM. Emergency department thoracotomy. Semin Thorac Cardiovasc Surg. 2008;20(1):13–8.PubMedCrossRef
38.
Morgan BS, Garner JP. Emergency thoracotomy—the indications, contraindications and evidence. J R Army Med Corps. 2009;155(2):87–93.PubMed
39.
Soffer D, McKenney MG, Cohn S, Garcia-Roca R, Namias N, Schulman C, Lynn M, Lopez P. A prospective evaluation of ultrasonography for the diagnosis of penetrating torso injury. J Trauma. 2004;56(5):953–7. (discussion 957–959).PubMedCrossRef
40.
van den Berg HR, Lere SG, Schipper IB, Patka P. Abdominal gunshot wounds: possibilities for selective conservative management. Ned Tijdschr Geneeskd. 2007;151(15):841–7.PubMed
41.
de Vries CS, Africa M, Gebremariam FA, van Rensburg JJ, Otto SF, Potgieter HF. The imaging of stab injuries. Acta Radiol. 2010;51(1):92–106.PubMedCrossRef
42.
Salera D, Argalia G, Giuseppetti GM. Screening US for blunt abdominal trauma: a retrospective study. Radiol Med. 2005;110(3):211–20.PubMed
43.
Brown MA, Casola G, Sirlin CB, Patel NY, Hoyt DB. Blunt abdominal trauma: screening us in 2,693 patients. Radiology. 2001;218(2):352–8.PubMed
44.
Lingawi SS, Buckley AR. Focused abdominal US in patients with trauma. Radiology. 2000;217(2):426–9.PubMed
45.
Nural MS, Yardan T, Guven H, Baydin A, Bayrak IK, Kati C. Diagnostic value of ultrasonography in the evaluation of blunt abdominal trauma. Diagn Interv Radiol. 2005;11(1):41–4.PubMed
46.
Arom KV, Richardson JD, Webb G, Grover FL, Trinkle JK. Subxiphoid pericardial window in patients with suspected traumatic pericardial tamponade. Ann Thorac Surg. 1977;23(6):545–9.PubMedCrossRef
47.
Navsaria PH, Nicol AJ. Haemopericardium in stable patients after penetrating injury: is subxiphoid pericardial window and drainage enough? A prospective study. Injury. 2005;36(6):745–50.PubMedCrossRef
48.
Trunkey D. Initial treatment of patients with extensive trauma. N Engl J Med. 1991;324(18):1259–63.PubMedCrossRef
49.
Molina EJ, Gaughan JP, Kulp H, McClurken JB, Goldberg AJ, Seamon MJ. Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective. Interact Cardiovasc Thorac Surg. 2008;7(5):845–8.PubMedCrossRef
Metadata
Title
Immediate thoracotomy for penetrating injuries: ten years’ experience at a Dutch level I trauma center
Authors
O. J. F. Van Waes
P. A. Van Riet
E. M. M. Van Lieshout
D. D. Hartog
Publication date
01-10-2012
Publisher
Springer-Verlag
Published in
European Journal of Trauma and Emergency Surgery / Issue 5/2012
Print ISSN: 1863-9933
Electronic ISSN: 1863-9941
DOI
https://doi.org/10.1007/s00068-012-0198-6

Other articles of this Issue 5/2012

European Journal of Trauma and Emergency Surgery 5/2012 Go to the issue

Short Communication

Acute care surgery in the USA: the orthopaedic conflict

Original Article

Intestinal obstruction due to bezoars: a retrospective clinical study

Original Article

The management of complex acetabular fractures in the elderly with fracture fixation and primary total hip replacement

Original Article

Blind subxiphoid pericardiotomy to relieve critical acute hemopericardium: a final report

Original Article

Rectus sheath haematoma: are there prognostic risk factors of haemodynamic instability motivating an early operative treatment?

Editorial Comment

Editorial Comment