"Cardiac Arrest survival following Chest Trauma-Does Emergency Department Thoracotomy Result in Superior Survival Rates Compared to Pre-Hospital Thoracotomy?"

Report By: Dr Charlotte Elizabeth Evans - Emergency Medicine ST6
Search checked by Dr Charlotte Elizabeth Evans - Emergency Medicine ST6
Institution: Royal Free Hospital
Date Submitted: 22nd August 2010
Last Modified: 22nd August 2010
Status: Blue (submitted but not checked)

Three Part Question

In [cardiac arrest patients following chest trauma] does [emergency department thoracotomy] result in [superior survival rates compared to pre-hospital thoracotomy]

Clinical Scenario

In patients suffering traumatic cardiac arrest does emergency department thoracotomy result in superior survival rates compared to pre-hospital thoracotomy?

Search Strategy

A literature search was performed using ovid (medline 1950-June week 2 2009) and using evidence based reviews present in Bandolier, Cochrane database, DARE , HTA Database,NHS EDD, UK DUETS, AMED,British Niursing Index,CINAHL,E-Books,HMIC,Medline My Journals,PsycINFO and PUBMEDLibrary.net
A) The ovid medline search strategy used were:
1. [cardiac arrest.mp.] or [exp heart arrest]/ (30819)
2. [traumatic cardiac arrest.mp.] (62)
3. [wounds and injuries]/ (36372)
4. 1 and 3 (110)
5. 4 or 2 (165)
6. [thoracotomy.mp. or thoracotomy/ (15911)
7. 6 and 5 (17)
8. [out of hospital thoracotomy.mp.]/ (15911)
9. ((“on-scene thoracotomy” or “emergency room thoracotomy” or paramedic) adj3 thoracotomy).mp. (mp=title,original title,abstract,name of substance word,subject heading word] (69)
10. 8 or 7 or 9 (84)
11. (survival or mortality or outcome or fatal or success).mp. (1862954)
12. 11 and 10 (64)
13. limit 12 to abstracts (62)
14. from 13 keep 1-62 (62)

A literature search was performed using ovid (medline 1950-June week 2 2009) and using evidence based reviews present in Bandolier, Cochrane database, DARE , HTA Database,NHS EDD, UK DUETS, AMED,British Niursing Index,CINAHL,E-Books,HMIC,Medline My Journals,PsycINFO and PUBMEDLibrary.net

Search Outcome

Emergency department thoracotomy data was found exclusively in 84 papers.
Pre-hospital versus emergency department thoracotomy data was found in only 3 papers.

Comment(s)

The process of emergent thoracotomy is multifactorial and complex. Although ED thoracotomy survival rates are superior this is likely a reflection of the cardiovascular status of those arriving in the ED with thoracic trauma and signs of life. Although the only paper to statistically analyse this question demonstrated the location of thoracotomy to have no bearing on survival.

Clinical Bottom Line

Emergency Department thoracotomy rates are superior compare to pre-hospital thoracotomy rates. Statistical tests demonstrate prehospital thoracotomy does not adversely effect outcome.