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1: J Trauma. 2001 Jun;50(6):1027-30. Links

Emergency room thoracotomy for penetrating chest injury: effect of an institutional protocol.

Aihara R, Millham FH, Blansfield J, Hirsch EF.

Department of Surgery, Section on Trauma, Boston Medical Center, Boston University School of Medicine, Boston, MA 02118, USA. rie.aihara@bmc.org

BACKGROUND: Emergency room thoracotomy (ERT) can be life saving in patients with penetrating chest injury. A protocol was established at our institution stating that ERT be performed for cases of cardiac tamponade secondary to penetrating chest trauma on patients with vital signs/mentation in the field or on arrival to the emergency room. To validate our protocol, we reevaluated patients undergoing ERT at our institution. METHODS: In our retrospective review, there were 49 patients undergoing ERT over a 6-year period. RESULTS: Survival in patients with vital signs was approximately 50%. Survival in those without was 0%. Compared with the preprotocol data, the number of ERTs declined from 32.2 cases per year to 8.1 cases per year. Overall survival increased from 4% to 20%. Neurologic outcome remained unchanged. CONCLUSION: We believe that the data validate our protocol, and the establishment of a guideline has enabled us to maximize patient survival and minimize exposure risks to our staff.

PMID: 11426116 [PubMed - indexed for MEDLINE]