Longterm Outcomes after Combat Casualty Emergency Department Thoracotomy
Abstract presented at the American College of Surgeons 94th Annual Clinical Congress, San Francisco, CA, October 2008.
Received 31 December 2008; received in revised form 11 March 2009; accepted 11 March 2009.
Background
The incidence, survival, and blood product use after emergency department thoracotomy (EDT) in combat casualties is unknown.
Study Design
We performed a prospective and retrospective observational study of EDT at a combat support hospital in Iraq, evaluating the impact of injury mechanisms, blood product use, mortality, and longterm neurologic outcomes of survivors.
Results
From November 2003 to December 2007, 12,536 trauma admissions resulted in 101 EDTs (0.01%). In patients undergoing EDT, penetrating trauma from explosions and firearms accounted for the majority of injuries (93%). There were no survivors after EDT for blunt trauma (n=7). The areas of primary penetrating injury were the abdomen (30%), thorax (40%), and extremities (22%). Twelve percent (12 of 101) of all patients survived until evacuation, with the overall survival rate (8 to 26 months) of US casualties at 11% (6 of 53). There was no difference in survival seen in either injury mechanism or primary injury location. Signs of life were present in all overall survivors. Cardiopulmonary resuscitation (CPR) was performed in 92% (93 of 101) of all patients, and in 75% (9 of 12) of those evacuated. Mean (±SD) transfusion requirements for all patients were 15.0±12.7 U of RBC and 7.3±8.7 U of fresh frozen plasma during the initial resuscitation. Survivors demonstrated higher fresh frozen plasma:RBC ratios. All survivors were neurologically intact.
Conclusions
In the combat casualty with penetrating injury, arriving with signs of life, receiving CPR, and undergoing EDT, longterm survival with normal neurologic outcomes is possible. CPR is not a contraindication to performance of EDT in penetrating injuries if signs of life are present. A large amount of blood products are used in the resuscitation of EDT patients.
Correspondence address: Lorne H Blackbourne, MD, US Army Institute of Surgical Research, 3400 Rawley E Chambers Ave, Fort Sam Houston, TX 78234
Disclosure Information: Nothing to disclose.
The opinions or assertions contained herein are the private views of the authors and are not to be construed as official or as reflecting the views of the Department of the Army or the Department of Defense.
ABSTRACT