[Peri-arrest emergency thoracotomy after trauma: a 5-year case series].

Abstract

Background: Emergency thoracotomy under cardiopulmonary resuscitation (CPR) conditions in polytrauma patients remains a high-risk intervention with significant mortality. This study aims to evaluate outcomes following emergency thoracotomy in this critically injured patient population.

Methods: A retrospective analysis was conducted on patients who underwent emergency thoracotomy for polytrauma between 2019 and 2023. The primary outcome was survival to hospital discharge. Functional outcome was assessed using the Glasgow Outcome Scale (GOS).

Results: In this study 29 patients were included, 69% sustained blunt trauma and 31% penetrating injuries. Overall survival was 17% (n = 5). Mean time from emergency department arrival to thoracotomy was 19 ± 16.9 min and the prehospital time averaged 62 ± 53.1 min. The median Injury Severity Score (ISS) was 68.16 ± 16.97. Survivors had significantly lower ISS scores (32.6 ± 16.62; p < 0.001). Among patients with isolated injuries (24%), the survival rate was 43%. All survivors achieved a favorable outcome (GOS = 5). Factors associated with survival included short prehospital time, stab wounds and preserved consciousness after trauma.

Conclusion: Emergency thoracotomy in the context of severe polytrauma can be lifesaving, particularly in select patients with penetrating injuries and preserved neurological status. Survivors can achieve excellent functional outcomes. Further research is needed to define selection criteria and develop standardized treatment algorithms.