Resuscitative Thoracotomy following Wartime Injury
ARMY INST OF SURGICAL RESEARCH FORT SAM HOUSTON TX
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BACKGROUND The evidence for resuscitative thoracotomy RT in trauma patients following wartime injury is limited its indications and timings are less defined in battle injury. The aim of this study was to analyze survival as well as the causes and times of death in patients undergoing RT within the context of modern battlefield resuscitation. METHODS A retrospective cohort study was performed on consecutive admissions to a Field Hospital in Southern Afghanistan. All patients undergoing RT were identified using the UK Joint Theatre Trauma Registry. The primary outcome was 30-day mortality, and secondary outcomes included location of cardiac arrest, time from arrest to thoracotomy, and proportion achieving a return of spontaneous circulation. RESULTS Between April 2006 to March 2011, 65 patients underwent RT with 14 survivors 21.5. Ten patients 15.4 had an arrest in the field with no survivors, 29 44.6 had an arrest en route with 3 survivors, and 26 40.0 had an arrest in the emergency department with 11 survivors. There was no difference in Injury Severity Scores ISSs between survivors and fatalities 27.3 7.6 vs. 36.0 22.1, p 0.636. Survivors had a significantly shorter time to thoracotomy than did fatalities 6.15 5.8minutes vs. 17.7 12.63 minutes, p G 0.001. CONCLUSION RT following combat injury will yield survivors. Best outcomes are in patients who have an arrest in the emergency department or on admission to the hospital.
- Medicine and Medical Research