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Resuscitative thoracotomy following wartime injury

Morrison, Jonathan J. MRCS; Poon, Henrietta MRCS; Rasmussen, Todd E. MD; Khan, Mansoor A. FRCS; Midwinter, Mark J. MR, FRCS; Blackbourne, Lorne H. MD; Garner, Jeffery P. MD, FRCS

Journal of Trauma and Acute Care Surgery: March 2013 - Volume 74 - Issue 3 - p 825–829
doi: 10.1097/TA.0b013e31827e1d26
Original Articles

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 [5.8] minutes vs. 17.7 [12.63] minutes, p < 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.

LEVEL OF EVIDENCE Epidemiologic/prognostic study, level III.

From the US Army Institute of Surgical Research (J.J.M., H.P., T.E.R.), Fort Sam Houston, Texas; R Adams Cowley Shock Trauma Center (M.A.K.), University of Maryland, Baltimore, Maryland; and Academic Department of Military Surgery and Trauma (J.J.M., M.A.K., M.J.M.), Royal Centre for Defence Medicine, Birmingham; and Rotterham NHS Foundation Trust (J.P.G.), Rotterham, United Kingdom.

Submitted: June 23, 2012, Revised: October 13, 2012, Accepted: October 19, 2012.

This study was presented as a poster at the 71st annual meeting of the American Association for the Surgery of Trauma, September 12–15, 2012, in Kauai, Hawaii.

Address for reprints: Jonathan James Morrison, MB, ChB, Academic Department Military Surgery and Trauma, Royal Centre for Defence Medicine, Joint Medical Command, Vincent Dr, Birmingham, B15 2SQ; email:

© 2013 Lippincott Williams & Wilkins, Inc.