Review of emergency thoracotomy for chest injuries in patients attending a UK Accident and Emergency department.

Over a two and a half year period, 25 patients presenting to the Glasgow Royal Infirmary underwent emergency thoracotomy for suspected severe chest injuries. Eighteen (72 per cent) were performed in the Accident and Emergency (A&E) department and seven (28 per cent) in a fully equipped operating theatre after resuscitation. There were 23 men and 2 women. Twenty-three (92 per cent) had been stabbed, one (4 per cent) had been shot and one (4 per cent) had sustained a blunt injury in a road traffic accident. Eight (32 per cent) patients survived. All survivors had been stabbed and seven were well enough to undergo thoracotomy in theatre. Only one (5.6 per cent) of the patients operated upon in the A&E department survived to discharge, although three (16.8 per cent) survived the initial procedure. Three of four patients survived, in whom the diagnosis of cardiac tamponade was initially missed. Thirteen (76.5 per cent) of the 17 who did not survive had no vital signs on admission. Outcomes may be improved if appropriately trained hospital staff are immediately available and prehospital delays are minimized so that patients arrive sooner with signs of life still present. Ambulance paramedic interventions have little to offer these patients and may worsen the prognosis if they result in delayed transport to hospital. The emphasis placed on diagnosis and treatment of cardiac tamponade in Advanced Trauma Life Support programmes is appropriate and all staff involved in these cases should undergo this type of training.