Emergency Medicine Literature of Note - July 3, 2105 - Posted by Ryan Radecki
"This is an evidence synthesis performed by a group of authors affiliated with the Eastern Association for the Surgery of Trauma, addressing the topic of patient selection for Emergency Department thoracotomy. Screening 2,152 studies to review, ultimately, 72, these authors review a total of 10,238 patient encounters in which patients underwent ED thoracotomy. This results in six recommendations for patients presenting pulseless to the Emergency Department after trauma:
- In patients with signs of life after penetrating thoracic injury: strongly recommend EDT.
- In patients without signs of life after penetrating thoracic injury: conditionally recommend EDT.
- In patients with signs of life after penetrating extra-thoracic injury: conditionally recommend EDT.
- In patients without signs of life after penetrating extra-thoracic injury: conditionally recommend EDT.
- In patients with signs of life after blunt injury: conditionally recommend EDT.
- In patients without signs of life after blunt injury: conditionally recommend against EDT.
However, before you start rummaging around in your toolbox for the rib spreaders, it should be recognized the conditional recommendations – except in penetrating thoracic injury – result in absolute intact survival increases only in the range of 20-40 patients per 1000."
“An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma”