Ontemporary Utilization of Resuscitative Thoracotomy: Results from the AAST Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery (AORTA) Multicenter Registry
Several reviews of Resuscitative thoracotomy (RT) use over the last 5 decades have been conducted, most recently the evidence-based practice management guideline (PMG) of the Eastern Association for the Surgery of Trauma (EAST). The present study was designed to examine contemporary RT utilization and outcomes compared to historical data (n = 10,238) from the EAST PMG review from published series 1974 – 2013.Methods:
The AAST AORTA registry was utilized to identify patients undergoing RT in the ED from Nov 2013 to Dec 2016. Demographics, injury data, physiologic presentation and outcomes were reviewed and compared to those of the EAST PMG review.Results:
Three-hundred and ten RT patients from 16 contributing AORTA centers were identified. The majority were injured by penetrating mechanisms (197/310, 64% [gunshot (163/197, 83%)]). Signs of life (SOL) (organized electrical activity, pupillary response, spontaneous movement or appreciable pulse/blood pressure) were present on arrival in 47% (147/310). When compared to the EAST PMG results, there was no difference in either hospital survival (5% vs. 8%) or neurologically intact survival between historical controls or AORTA registry patients in any category combination of mechanism / anatomic location / presenting signs of life. Blunt injuries W/O SOL on admission continue to constitute 14% (45/310) of RTs in the Emergency Department, without documented survivors.Conclusion:
Comparison of historical RT controls to more contemporary patients from the AORTA registry suggests that practices and outcomes following RT have not changed. Despite a wealth of accumulated data over several decades, RT continues to be performed for patients after blunt mechanisms of injury who present W/O SOL despite lack of demonstrated hope for survival benefit.