Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western XXXX Association perspective.

@entity1 @entity764 @entity1167 @entity67 @entity130
BACKGROUND: Since the promulgation of emergency department (ED) thoracotomy>40 years ago, there has been an ongoing search to define when this heroic resuscitative effort is futile. In this era of health care reform, generation of accurate data is imperative for developing @entity1 care guidelines. The purpose of this prospective multicenter study was to identify injury patterns and physiologic profiles at ED arrival that are compatible with survival. METHODS: Eighteen institutions representing the Western @entity130 Association commenced enrollment in January 2003; data were collected prospectively. RESULTS: During the ensuing 6 years, 56 @entity1 survived to hospital discharge. Mean age was 31.3 years (15-64 years), and 93% were male. As expected, survival was predominant in those with @entity764 (77%), followed by abdomen (9%), extremity (7%), neck (4%), and head (4%). The most common injury was a @entity67 wound (30%), followed by a gunshot wound to the lung (16%); 9% of survivors sustained blunt @entity130 , 34% underwent prehospital cardiopulmonary resuscitation (CPR), and the presenting base deficit was >25 mequiv/L in 18%. Relevant to futile care, there were survivors of blunt torso injuries with CPR up to 9 minutes and penetrating torso wounds up to 15 minutes. @entity1167 was documented at ED arrival in seven @entity1 (12%); all these @entity1 had pericardial tamponade and three (43%) had good functional neurologic recovery at hospital discharge. CONCLUSION: Resuscitative thoracotomy in the ED can be considered futile care when (a) prehospital CPR exceeds 10 minutes after blunt @entity130 without a response, (b) prehospital CPR exceeds 15 minutes after penetrating @entity130 without a response, and (c) asystole is the presenting rhythm and there is no pericardial tamponade.
