Is there any role for resuscitative emergency department thoracotomy in blunt trauma?

Maziar Khorsandi*, Christos Skouras, Rajesh Shah

*Corresponding author for this work

Research output: Contribution to journalArticlepeer-review

Abstract / Description of output

A best evidence topic in cardiothoracic surgery was written according to a structured protocol. The question addressed was whether there is any role for resuscitative emergency department thoracotomy in severe blunt trauma. Emergency thoracotomy is an accepted intervention for patients with penetrating cardiothoracic trauma. However, its role in blunt trauma has been challenged and has been a subject of considerable debate. Altogether, 186 relevant papers were identified, of which 14 represented the best evidence to answer the question. The author, journal, date, country of publication and relevant outcomes are tabulated. The 14 studies comprised 2 systematic reviews and 12 retrospective studies. The systematic review performed by the Trauma Committee of the American College of Surgeons included 42 studies and a cumulative total of 2193 blunt trauma patients who underwent an emergency department thoracotomy, reporting a survival rate of 1.6%. According to this review, 15% of the survivors suffered from neurological sequelae, but survivors from both penetrating and blunt trauma were included. A systematic review comprising 24 studies reported a survival rate of 1.4% among 1047 blunt trauma patients. Of the retrospective studies, 11 report poor survival rates, ranging from 0 to 6%. Only one study reports a higher survival rate (12.2%). Five of the studies reported on the neurological outcome of survivors. The majority of the studies suffered from limitations due to the small number of included cases. The reported survival after an emergency department thoracotomy for blunt trauma is very low in the vast majority of available studies. Furthermore, the neurological sequelae in the few survivors are frequent and severe. Interestingly, some author groups recommend that emergency department thoracotomy should be contraindicated in cases of blunt trauma with no signs of life at the scene of trauma or on arrival at the emergency department. Larger, well-designed series will be required to reach a consensus on valid prognostic factors and specific subgroups of blunt trauma patients with substantial chances of survival.

Original languageEnglish
Pages (from-to)509-516
Number of pages8
JournalInteractive cardiovascular and thoracic surgery
Issue number4
Publication statusPublished - Apr 2013

Keywords / Materials (for Non-textual outputs)

  • Thoracic
  • Emergency department
  • Thoracotomy
  • Blunt trauma


Dive into the research topics of 'Is there any role for resuscitative emergency department thoracotomy in blunt trauma?'. Together they form a unique fingerprint.

Cite this