Dayama Anand, Sugano Dordaneh, Spielman Daniel, Stone Melvin E, Kaban Jody, Mahmoud Ahmed, McNelis John
San Joaquin General Hospital, University of California, Davis, French Camp, California, USA.
Jacobi Medical Center, Albert Einstein College of Medicine, Bronx, New York, USA.
ANZ J Surg. 2016 Jan-Feb;86(1-2):21-6. doi: 10.1111/ans.13227. Epub 2015 Jul 14.
Emergency department thoracotomy (EDT) is a formidable and dramatic last attempt by the trauma surgeon to save the life of a patient in extremis. The aim of this report is to provide a benchmark for comparison with past results by reviewing all available published data since the American College of Surgeons Committee on Trauma review article in 2001, which reviewed literature from 1966 to 1999 regarding indications for and outcomes of EDT.
A comprehensive literature search in MEDLINE Library databases was performed for EDT. Data were extracted by three independent reviewers.
We identified 37 papers with a total of 3466 patients. A total of 85.2% (1720 of the 2018) had penetrating trauma, 58.3% (372 of the 638) had cardiac injuries, 43.0% (251 of the 584) had thoracic injuries and 26.2% (143 of the 546) had abdominal injuries. The overall rate survival in this review was 8% (267 of the 3466, range 0-33.3%). Of 25 papers reporting cases of EDT for penetrating traumas, their survival rate was 9.8% (169 of the 1719, range 0-45.5); similarly, of 14 papers assessing EDT for blunt injuries, the survival rate was 5.2% (24 of the 460, range 0-12.2). Of 15 papers reporting neurological outcomes 84.6% (143 of the 169, range 50-100%) of patients returned to baseline. The survival outcome of EDT in US experience versus non-US experiences was 6.3% (164 of the 2612, range 0-14.9) versus 11.9% (89 of the 745, range 0-33.3) respectively.
The authors intend this review to serve as a practical and prompt literature search tool for all surgeons who encounter resuscitative thoracotomy in their practice.
急诊开胸手术（EDT）是创伤外科医生为挽救处于危急状态患者生命而采取的一项艰巨且具有戏剧性的最后尝试。本报告的目的是通过回顾自2001年美国外科医师学会创伤委员会综述文章以来所有已发表的可用数据，提供一个与过去结果进行比较的基准，该综述文章回顾了1966年至1999年有关急诊开胸手术的指征和结果的文献。
在MEDLINE图书馆数据库中对急诊开胸手术进行了全面的文献检索。数据由三名独立评审员提取。
我们确定了37篇论文，共涉及3466例患者。共有85.2%（2018例中的1720例）为穿透性创伤，58.3%（638例中的372例）有心脏损伤，43.0%（584例中的251例）有胸部损伤，26.2%（546例中的143例）有腹部损伤。本综述中的总体生存率为8%（3466例中的267例，范围为0 - 33.3%）。在25篇报告穿透性创伤急诊开胸手术病例的论文中，其生存率为9.8%（1719例中的169例，范围为0 - 45.5%）；同样，在14篇评估钝性损伤急诊开胸手术的论文中，生存率为5.2%（460例中的24例，范围为0 - 12.2%）。在15篇报告神经学结果的论文中，84.6%（169例中的143例，范围为50 - 100%）的患者恢复到基线水平。美国经验与非美国经验中急诊开胸手术的生存结果分别为6.3%（2612例中的164例，范围为0 - 14.9%）和11.9%（745例中的89例，范围为0 - 33.3%）。
作者希望本综述能成为所有在实践中遇到复苏性开胸手术的外科医生实用且便捷的文献检索工具。
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