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Emergency Thoracotomy Saves Lives in a Scandinavian Hospital Setting

Pahle, Andreas Saxlund; Pedersen, Bastian Løe; Skaga, Nils Oddvar MD, PhD; Pillgram-Larsen, Johan MD

Journal of Trauma-Injury Infection & Critical Care: March 2010 - Volume 68 - Issue 3 - pp 599-603
doi: 10.1097/TA.0b013e3181a5ec54
Original Article

Background: Emergency thoracotomy (ET) is a life-saving procedure used to control hemorrhage and relieve cardiac tamponade. It has been in routine use at Ulleval University Hospital since 1987. Our objective was to see the outcome of patients subjected to ET in recent times.

Methods: One hundred and nine consecutive ET performed in our emergency department during a 6-year period were analyzed. Data were drawn from the hospital's trauma registry. Demographics, mechanism of injury, anatomic injuries, physiologic status, interventions, time lapse, and outcome 30 days after injury were registered prospectively.

Results: Ten of 27 patients with penetrating (37%) and 10 of 82 patients with blunt injuries (12%) survived, giving a total survival of 18%. Median (quartiles) for the following parameters were Injury Severity Score 38 (26-50), Revised Trauma Score 1.3 (0-3.9), Glasgow Coma Scale score 3 (3-6), and probability of survival 0.06 (0.001-0.22). Survivors from penetrating injuries had significantly lower Injury Severity Score (25 vs. 34, p = 0.003), higher Revised Trauma Score (3.92 vs. 0.00, p < 0.001), higher Glasgow Coma Scale score (8 vs. 3, p < 0.001), and higher probability of survival (0.74 vs. 0.01, p < 0.001) than nonsurvivors. Conversely, no such differences were found for patients with blunt injury. Multiple logistic regression analysis failed to reveal any predictors of survival.

Conclusion: An overall survival of 18% suggests that ET is a life saving procedure. It is difficult to find good predictors of survival from logistic regression analysis. It should, for a trained trauma team, be a liberal attitude toward performing the procedure on the agonal patient.

From the Department of Cardiothoracic Surgery (A.S.P., B.L.P.), Ulleval University Hospital, Oslo, Norway; Departments of Anesthesia (N.O.S.) and Cardiothoracic Surgery (J.P.-L.), Ulleval University Hospital, Oslo, Norway.

Submitted for publication September 30, 2008.

Accepted for publication February 6, 2009.

The first two authors contributed equally to this work.

Address for reprints: Johan Pillgram-Larsen, MD, Department of Cardiothoracic Surgery, Ulleval University Hospital, 0407 Oslo, Norway; email:

© 2010 Lippincott Williams & Wilkins, Inc.