ORIGINAL ARTICLES   

Chirurgia 1999 October;12(5):345-8

Copyright © 1999 EDIZIONI MINERVA MEDICA

language: Italian

Emergency thoracotomy

Pagan V., Moretti R., Busetto A., Barbaresco S., Fontana P.

Background. The usefulness of emergency thoracotomy is still controversial. Personal experience on the role of emergency thoracotomy is presented.
Methods. In the last twenty years 159 patients with thoracic injuries (12% of all our patients with chest trauma) have been treated by surgical exploration. Forty-two patients underwent an emergency thoracotomy (EMT): 23 for blunt chest trauma and 19 for penetrating injuries. The EMT was required mostly because of hemorrhagic shock (76%), followed by cardiac injury or tamponade (17%), and respiratory distress (7%). An anterior or antero-lateral thoracotomic access was preferentially adopted. 85% of EMTs was performed in the O.R. (mortality 35%), 12% in the E.R. (mortality 60%) and 5% in the diagnostic setting or en route for the O.R. (mortality 100%). Extracorporeal circulatory assistance has been employed in 5 patients and intraoperative autotransfusion in 10.
Results. Twenty-five patients survived, for an overall survival of 59%. Half of the deaths occurred during thoracotomy and the other half postoperatively, most of them due to multiorgan failure.
Conclusions. In this series emergency thoracotomy showed to improve the prognosis of both severe blunt and penetrating chest trauma.