engleski

The new indications in emergency thoracotomy

Background: Emergency thoracotomy is a procedure which enables access to the internal organs of the thorax in critically injured or ill patients, and so allows for internal cardiac massage, which improves the systemic and cardiopulmonary circulations, and protects the central nervous system. Today, the main indication for the procedure is the penetrating trauma to the thorax, because earlier studies in the United States and South Africa showed that such patients have the highest rates of survival. However, many modern studies are showing a higher survival rate in blunt thoracic trauma, in extra-thoracic injury, in nontraumatic cardiorespiratory arrest, and in pediatric trauma. New indications in emergency thoracotomy are warranted. Methods: We did a systematic review research of the role of emergency thoracotomy in blunt thoracic trauma, penetrating thoracic trauma, nontraumatic cardiac arrest, and in pediatric blunt and penetrating thoracic trauma. The pubmed database was primarly used for the obtainment of research articles. The keywords used were emergency thoracotomy in blunt thoracic trauma with 247 total articles obtained, emergency thoracotomy in penetrating trauma with 277 total articles obtained, resuscitative thoracotomy and nontraumatic cardiac arrest with a total of 3 research articles obtained, emergency thoracotomy and pediatric blunt thoracic trauma with a total of 17 research articles obtained, and emergency thoracotomy and pediatric penetrating thoracic trauma with a total of 131 articls obtained. Of these we chose to work with those articles which exlusively researched cardiac arrest caused by the above mentioned mechanisms. Results: Articles published in past decade in Europe and Japan have shown increased percentages of survival after blunt thoracic trauma. A review article from Europe reported survival rates of blunt thoracic trauma ranging from 12% to 60%. One article showed how survival could be increased by 31%. In nontraumatic cardiac arrest, ROSC rates can be increased to 80% even after 35 minutes of unsuccesful classic CPR, and they appear to be two times higher in asystolic patients. Recent research in pediatric trauma showed that 75% of emergency thoracotomy survivors sustained blunt thoracic trauma. Discussion: Modern research from Europe and Japan has repeatedly shown higher survival percentages of emergency thoracotomy, after blunt thoracic trauma. Furthermore, in nontraumatic cardiac arrest, internal heart massage of the open thorax increases the chances of survival even after 15 to 20 minutes of unsuccessful classic cardiopulmonary resuscitation. Even though earlier studies from the United States have not proven the utility of emergency thoracotomy in the pediatric population, the latest research in the war zones of Iraq and Afghanistan has done so. Cohort groups where emergency thoracotomy was done have shown higher survival and discharge from the hospital rates than cohort groups where classic CPR was done. In addition, 75% of the survivors sustained blunt thoracic trauma, while previous studies showed 0% survival. Emergency thoracotomy increases the chances of survival and a neurologically intact recovery, after serious trauma including blunt injury to the thorax, as well as in nontraumatic cardiac arrest, in both pediatric and adult populatons. The indications should be revised.

emergency, thoracotomy, indication, blunt, penetrating, thoracic, trauma, adult, pediatric, nontraumatic, cardiorespiratory, arrest, systematic review

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