Resuscitative thoracotomy for patients with traumatic injury

The clinical course and final outcome were determined for 63 trauma victims who underwent resuscitative thoracotomy (RT) for hypovolemic cardiac arrest in the Department of Emergency Medicine during a 24-month period. The objectives of the study were to determine the efficacy of and indications for RT and to define the prognostic signs for survival. Of 63 patients, six were successfully resuscitated (9.5%), and five of these were discharged from the hospital (7.9%). The presence of pupillary reactions was an extremely reliable indicator of successful outcome (P = 0.0009), as was the presence of some respiratory effort (P = 0.025). None of the victims of blunt trauma (n = 6) or severe head injury (n = 13) survived. Three of 17 patients (17.6%) with stab wounds and two of 36 (5.6%) with gunshot wounds survived the procedure. RT was beneficial in 13.6% of patients who had isolated organ system injuries, but no patient with injuries to more than two organ systems survived. Victims of isolated penetrating thoracic trauma had an 11.8% survival rate, as opposed to a 0% survival rate for those with abdominal trauma. The best prognosis was in victims with penetrating cardiac injuries, who had a 22.7% survival rate. The cost of RT averaged $1660 per patient, exclusive of physician charges. In our experience, RT is most beneficial for victims of penetrating thoracic trauma, especially those with cardiac injuries. However, routine use of this high cost/low benefit procedure cannot be recommended for patients who have cardiac arrest secondary to blunt trauma or severe head injuries. Also, it is not recommended for patients whose pupillary reflexes and respiratory movements are absent.