REAPPRAISAL OF EMERGENCY ROOM THORACOTOMY IN A CHANGING ENVIRONMENT

被引：95
作者：
ESPOSITO, TJ [1 ]
JURKOVICH, GJ [1 ]
RICE, CL [1 ]
MAIER, RV [1 ]
COPASS, MK [1 ]
ASHBAUGH, DG [1 ]
机构：
[1] UNIV WASHINGTON,HARBORVIEW MED CTR,DEPT SURG,SEATTLE,WA 98104
来源：
JOURNAL OF TRAUMA-INJURY INFECTION AND CRITICAL CARE | 1991年 / 31卷 / 07期
关键词：
D O I：
10.1097/00005373-199107000-00001
中图分类号：
R4 [临床医学];
学科分类号：
1002 ; 100602 ;
摘要：
The efficacy of resuscitative emergency room thoracotomy (ERT), particularly in blunt injury, has been questioned. Wide application of the procedure may not be cost effective. The risk of exposure and lethal infection to medical personnel during ERT is considerable. For the past decade, the policy at this institution has been to perform ERT on all moribund patients sustaining penetrating torso injury and all patients sustaining blunt injury with any evidence of cardiac electrical activity. To evaluate whether such a liberal policy is currently justified, the charts of all patients undergoing ERT over a 4-year period were reviewed. One hundred twelve patients underwent ERT; 24 (21%) sustained penetrating injury, 88 (79%) blunt injury. The overall survival rate was 1.8%. Penetrating injury had a 4.2% survival and blunt injury 1.1%. No patients with CPR initiated at the scene and required throughout transport survived. In those patients with both blood pressure and spontaneous respirations present in the field, survival rate was 11.8%. Survival rate in patients manifesting sinus rhythm or ventricular fibrillation upon arrival at the ER was 6.4%. No survivors were noted among patients coming to the hospital with an idioventricular rhythm or asystole. The total hospital charges for patients undergoing ERT exceeded reimbursement by $59,565. Screening for HIV and hepatitis could be documented in only two patients; both were negative. Liberal performance of ERT has dismal results, incurs monetary loss, and affords a greater potential for exposure to lethal infection. Emergency room thoracotomy is justified only when vital signs or a resuscitatible cardiac rhythm are present in the field or ER and deteriorate shortly before thoracotomy. This policy maximizes survival while diminishing inappropriate expenditure of resources and risk to medical personnel.
引用
收藏
页码：881 / 887
页数：7
相关论文
共 28 条
  • [1] Harnar T.J., Oreskovich M.R., Copass M.K., Et al., Role of emergency thoracotomy in the resuscitation of moribund trauma victims: 100 consecutive cases, Am J Surg, 142, (1981)
  • [2] Baker C.C., Thomas A.N., Trunkey D.D., The role of emergency room thoracotomy in trauma, J Trauma, 20, (1980)
  • [3] Baxter B.T., Moore E.E., Moore J.B., Et al., Emergency department thoracotomy following injury: Critical determinants for patient salvage, World J Surg, 12, (1988)
  • [4] Cogbill T.H., Moore E.E., Millikan J.S., Et al., Rationale for selective application of emergency department thoracotomy in trauma, J Trauma, 23, (1983)
  • [5] Danne P.D., Finelli F., Champion H.R., Emergency bay thoracotomy, J Trauma, 24, (1984)
  • [6] Vig D., Simoni E., Tomlanovich M., Et al., Resuscitative thoracotomy for trauma (Abstract), Crit Care Med, 11, (1983)
  • [7] Vig D., Simoni E., Smith R.F., Et al., Resuscitative thoracotomy for patients with traumatic injury, Surgery, 94, (1983)
  • [8] Bodai B.I., Smith J.P., Blaisdell F.W., The role of emergency room thoracotomy in blunt trauma, J Trauma, 22, (1982)
  • [9] Feliciano D.V., Bitondo C.G., Cruse P.A., Et al., Liberal use of emergency center thoracotomy, Am J Surg, 152, (1986)
  • [10] Clevenger F.W., Yarbrough D.R., Reines H.D., Resuscitative thoracotomy: The effects of field time on outcome, J Trauma, 28, (1988)
123