Prehospital emergency thoracotomy: is there any indication? Report of five cases and an algorithm

Objectives

To report five cases of emergency thoracotomy in a prehospital setting and its indication with an algorithm.

Materials and methods

A case report of five emergency thoracotomies for penetrating thoracic trauma, in a prehospital environment, in an advanced life support unit with a physician.

Results

All patients were male with a median age of 24 years and presented by a left penetrating thoracic trauma: two were gunshots, two were vehicle debris and one was stabbed. All of them had a hemothorax, two of them with cardiac injury (only one tamponated). Internal cardiac massage was performed in all patients, with return of a spontaneous circulation (ROSC) in two of them. One patient died at the scene, one in the emergency room, two in the operation room and the other 6 hours after surgery. Three patients had signs of life before the procedure and two of them had ROSC.

Conclusion

Emergency thoracotomy has a dismal result in a prehospital environment. Patients with signs of life before the procedure have the greatest chance of ROSC. An algorithm for rational use of emergency thoracotomy is proposed.