Longterm Outcomes after Combat Casualty Emergency Department Thoracotomy
Abstract
The incidence, survival, and blood product use after emergency department thoracotomy (EDT) in combat casualties is unknown. STUDY DESIGN: We performed a prospective and retrospective observational study of EDT at a combat support hospital in Iraq, evaluating the impact of injury mechanisms, blood product use, mortality, and longterm neurologic outcomes of survivors. RESULTS: From November 2003 to December 2007, 12,536 trauma admissions resulted in 101 EDTs (0.01%). In patients undergoing EDT, penetrating trauma from explosions and firearms accounted for the majority of injuries (93%).There were no survivors after EDT for blunt trauma (n = 7).The areas of primary penetrating injury were the abdomen (30%), thorax (40%), and extremities (22%).Twelve percent (12 of 101) of all patients survived until evacuation, with the overall survival rate (8 to 26 months) of US casualties at 11% (6 of 53).There was no difference in survival seen in either injury mechanism or primary injury location. Signs of life were present in all overall survivors. Cardiopulmonary resuscitation (CPR) was performed in 92% (93 of 101) of all patients, and in 75% (9 of 12) of those evacuated. Mean (+ or - SD) transfusion requirements for all patients were 15.0 + or - 12.7 U of RBC and 7.3 + or - 8.7 U of fresh frozen plasma during the initial resuscitation. Survivors demonstrated higher fresh frozen plasma:RBC ratios. All survivors were neurologically intact. CONCLUSIONS: In the combat casualty with penetrating injury, arriving with signs of life, receiving CPR, and undergoing EDT, longterm survival with normal neurologic outcomes is possible.
Document Details
- Document Type
- Technical Report
- Publication Date
- Aug 01, 2009
- Accession Number
- ADA627552
Entities
People
- Alec C. Beekley
- Brian J. Eastridge
- E. D. Cox
- Jason W. Edens
- John B Holcomb
- Kevin K Chung
- Lorne H Blackbourne
Organizations
- United States Army Institute of Surgical Research