UMEM Educational Pearls

Category: Trauma

Title: Go or no go: ED Resuscitative Thoracotomy for Trauma

Keywords: thoracotomy, REBOA, FAST, survival (PubMed Search)

Posted: 6/4/2023 by Robert Flint, MD (Updated: 4/24/2024)
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Bottom Line: Lack of pericardial fluid or cardiac motion on FAST exam leads to no intact survivors for ED RT for trauma.

Zone 1 REBOA may be as good or better than ED RT for those requiring aortic occlusion after trauma.

 

Intact neurologic survival after emergency department resuscitative thoracotomy (ED RT) for trauma is low. Best outcomes have been shown for stab wounds to the chest with loss of vital signs in the ED or just prior to ED arrival. Worst outcomes are for blunt trauma with loss of vital signs in the field.

Two studies help us further evaluate the use of emergency department resuscitative thoracotomy. Inaba et al. illustrate in patients undergoing a FAST exam prior to or concomitant with ED RT “The likelihood of survival if pericardial fluid and cardiac motion were both absent was zero.” Cralley et al. compared survival after ED RT to Resuscitative Endovascular Balloon Occlusion of the Artery (REBOA) zone 1 (above celiac axis) and found REBOA was as good or better when used in centers with experience with both procedures. They advocate for a randomized trial to compare the two procedures further.

References

Inaba, Kenji MD*; Chouliaras, Konstantinos MD*; Zakaluzny, Scott MD*; Swadron, Stuart MD†; Mailhot, Thomas MD†; Seif, Dina MD†; Teixeira, Pedro MD*; Sivrikoz, Emre MD*; Ives, Crystal MD*; Barmparas, Galinos MD*; Koronakis, Nikolaos MD*; Demetriades, Demetrios MD*. FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation. Annals of Surgery 262(3):p 512-518, September 2015. | DOI: 10.1097/SLA.0000000000001421

Alexis L. Cralley, MD1Navin Vigneshwar, MD, MPH1Ernest E. Moore, MD1,2; et al

Zone 1 Endovascular Balloon Occlusion of the Aorta vs Resuscitative Thoracotomy for Patient Resuscitation After Severe Hemorrhagic Shock JAMA Surg. 2023;158(2):140-150. doi:10.1001/jamasurg.2022.6393