Emergency thoracotomy in an urban community hospital: initial cardiac rhythm as a new predictor of survival.

Several authors have reviewed their experience with emergency thoracotomy in the university hospital setting. However, physicians in urban community hospitals are treating increasing numbers of patients who require emergency thoracotomy. To compare such experiences, the charts of all patients who underwent emergency thoracotomy in an urban community hospital during the years 1981 and 1982 were reviewed. In addition, the presenting cardiac rhythm was evaluated as a potential new prognosticator for survival in these patients. Forty-seven thoracotomies were performed during the two-year period. Thirty-nine (83%) were for penetrating trauma, of which 31 (66%) were for gunshot wounds and eight (17%) were for stab wounds. Eight patients (17%) underwent thoracotomy for blunt trauma. Of the 13 patients (28%) who survived and were discharged from the hospital, eight (17% of the total) had no neurological deficit. Twenty-five patients (53%) presented in sinus rhythm, 23 in sinus tachycardia, and two in normal sinus rhythm. All survivors beyond the operating room were in this group (P less than 0.001). Twenty-two patients (47%) presented in bradyasystolic rhythms, including bradycardia (four patients), agonal ventricular rhythm (five patients), ventricular fibrillation (three patients), and asystole (ten patients). None of these patients survived. The outcome data for community-hospital emergency thoracotomy are comparable with those of university centers where similar reviews were undertaken. The presenting cardiac rhythm is an accurate prognosticator of survival in patients undergoing emergency thoracotomy. Patients who present with sinus rhythms deserve aggressive resuscitation and emergency thoracotomy. Emergency thoracotomy does not improve the uniformly poor prognosis in patients presenting in bradyasystolic rhythms.