A retrospective review of EDT experience was performed. Data collected included injury mechanism and location, presence of measurable ED vital signs, initial ED cardiac rhythm, GCS, method of transportation, and survival. Ninety-four of 237 patients presented penetrating cardiac injuries after EDT. Eighty-nine patients (95%) were males. Measurable ED vital signs were present in 15 patients (16%).
Outcomes after emergency department thoracotomy for penetrating cardiac injuries: a new perspective. Molina EJ - Interact Cardiovasc Thorac Surg - 01-OCT-2008; 7(5): 845-8
Cardiac injuries were caused by GSW in 82 patients (87%) and SW in 12 patients (13%). Fifteen patients (16%) survived EDT and were taken to the operating room, while eight patients (8%) survived their entire hospitalization. All survivors were neurologically intact. Survival rates were 5% for GSW and 33% for SW . Mechanism of injury (SW), prehospital transportation by police, higher GCS, sinus tachycardia, and measurable ED vital signs were associated with improved survival..
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.
Emergency thoracotomy saves lives in a Scandinavian hospital setting. Pahle AS - J Trauma - 01-MAR-2010; 68(3): 599-603
Our primary study objective was to determine which patients requiring EDT for penetrating cardiac or great vessel (CGV) injury are salvageable . METHODS: All patients who underwent EDT for penetrating CGV injuries in two urban, level I trauma centers during 2000 to 2007 were retrospectively reviewed. Demographics, injury (mechanism, anatomic injury), prehospital care, and physiology (signs of life [SOL], vital signs, and cardiac rhythm) were analyzed with respect to hospital survival. RESULTS
Emergency department thoracotomy for penetrating injuries of the heart and great vessels: an appraisal of 283 consecutive cases from two urban trauma centers. Seamon MJ - J Trauma - 01-DEC-2009; 67(6): 1250-7; discussion 1257-8
CONCLUSION: When the cumulative impact of penetrating injury mechanism, ED SOL, and number of CGV wounds was analyzed together, we established that those sustaining multiple CGV GSWs (regardless of ED SOL) were nearly unsalvageable . These results indicate that when multiple CGV GSWs are encountered after EDT, further resuscitative efforts may be terminated without limiting the opportunity for survival
Perimortem Cesarean section in the helicopter EMS setting: a case report. - Kue R - Air Med J - 01-JAN-2008; 27(1): 46-7
Cardiac arrest in pregnancy: increasing use of perimortem caesarean section due to emergency skills training? Dijkman A - BJOG - 01-FEB-2010; 117(3): 282-7
RESULTS: During the study period, 55 women had a cardiac arrest, 12 of whom underwent a PMCS. Before the introduction of the MOET course, four PMCSs were performed (0.36/year), compared with eight cases after its introduction (1.6/year, P = 0.01). No PMCS was performed within the recommended 5 minutes after starting resuscitation. Eight of the twelve women (67%) regained cardiac output after PMCS, with two maternal and five neonatal survivors. Maternal case fatality rate was 83%. Neonatal case fatality rate was 58%.CONCLUSIONS: Since the introduction of the MOET course, the use of PMCS has increased. Outcome, however, was still poor. An important factor to improve outcome is more timely application of this potentially life-saving procedure.