TY - JOUR
T1 - Contemporary utilization of resuscitative thoracotomy
T2 - Results from the aast aortic occlusion for resuscitation in trauma and acute care surgery (aorta) multicenter registry
AU - DuBose, Joseph
AU - Fabian, Timothy
AU - Bee, Tiffany
AU - Moore, Laura J.
AU - Holcomb, John B.
AU - Brenner, Megan
AU - Skarupa, David
AU - Inaba, Kenji
AU - Rasmussen, Todd E.
AU - Turay, David
AU - Scalea, Thomas M.
N1 - Publisher Copyright:
© 2018 by the Shock Society.
PY - 2018
Y1 - 2018
N2 - Introduction: Several reviews of resuscitative thoracotomy (RT) use over the last five decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared with historical data (n 10,238) from the EAST PMG review from published series 1974 to 2013. Methods: The American Association for the Surgery of Trauma Aortic Occlusion for Trauma and Acute Care Surgery (AORTA) registry was utilized to identify patients undergoing RT in the emergency department (ED) from November 2013 to December 2016. Demographics, injury data, physiologic presentation, and outcomes were reviewed and compared with those of the EAST PMG review. Results: Three-hundred ten RT patients from 16 contributing AORTA centers were identified. The majority were injured by penetrating mechanisms (197/310, 64% [gunshot (163/197, 83%)]). Signs of life (SOL) (organized electrical activity, pupillary response, spontaneous movement, or appreciable pulse/blood pressure) were present on arrival in 47% (147/310). When compared with the EAST PMG results, there was no difference in either hospital survival (5% vs. 8%) or neurologically intact survival between historical controls or AORTA registry patients in any category combination of mechanism/anatomic location/presenting signs of life. Blunt injuries W/O SOL on admission continue to constitute 14% (45/310) of RTs in the ED, without documented survivors. Conclusion: Comparison of historical RT controls to more contemporary patients from the AORTA registry suggests that practices and outcomes following RT have not changed. Despite a wealth of accumulated data over several decades, RT continues to be performed for patients after blunt mechanisms of injury who present W/O SOL despite lack of demonstrated hope for survival benefit.
AB - Introduction: Several reviews of resuscitative thoracotomy (RT) use over the last five decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared with historical data (n 10,238) from the EAST PMG review from published series 1974 to 2013. Methods: The American Association for the Surgery of Trauma Aortic Occlusion for Trauma and Acute Care Surgery (AORTA) registry was utilized to identify patients undergoing RT in the emergency department (ED) from November 2013 to December 2016. Demographics, injury data, physiologic presentation, and outcomes were reviewed and compared with those of the EAST PMG review. Results: Three-hundred ten RT patients from 16 contributing AORTA centers were identified. The majority were injured by penetrating mechanisms (197/310, 64% [gunshot (163/197, 83%)]). Signs of life (SOL) (organized electrical activity, pupillary response, spontaneous movement, or appreciable pulse/blood pressure) were present on arrival in 47% (147/310). When compared with the EAST PMG results, there was no difference in either hospital survival (5% vs. 8%) or neurologically intact survival between historical controls or AORTA registry patients in any category combination of mechanism/anatomic location/presenting signs of life. Blunt injuries W/O SOL on admission continue to constitute 14% (45/310) of RTs in the ED, without documented survivors. Conclusion: Comparison of historical RT controls to more contemporary patients from the AORTA registry suggests that practices and outcomes following RT have not changed. Despite a wealth of accumulated data over several decades, RT continues to be performed for patients after blunt mechanisms of injury who present W/O SOL despite lack of demonstrated hope for survival benefit.
KW - Aortic Occlusion
KW - Emergency Department Thoracotomy
KW - Hemorrhage
KW - Injury
KW - Trauma
UR - http://www.scopus.com/inward/record.url?scp=85055506110&partnerID=8YFLogxK
U2 - 10.1097/SHK.0000000000001091
DO - 10.1097/SHK.0000000000001091
M3 - Article
C2 - 29280925
AN - SCOPUS:85055506110
SN - 1073-2322
VL - 50
SP - 414
EP - 420
JO - Shock
JF - Shock
IS - 4
ER -