EMERGENCY RESUSCITATIVE THORACOTOMY: OUTCOMES AND PREDICTORS OF FUTILITY IN A NATIONWIDE TRAUMA DATABASE
Vahe S. Panossian, Charlie J. Nederpelt, Alexander Bonde, Majed El Hechi, David C. Chang, April E. Mendoza, Noelle N. Saillant, Martin Rosenthal, Jarone Lee, Peter Fagenholz, David King, George Velmahos, Haytham M.A. Kaafarani Division of Trauma, Emergency Surgery and Surgical Critical Care, Massachusetts General Hospital, Boston, MA, USA
Background:
We sought to assess Emergency Resuscitative Thoracotomy (ERT) outcomes and predictors of futility using a nationwide database.
Methods:
Using a comprehensive algorithm combining specific ICD-9 and ICD-10 codes denoting the multiple ERT steps (e.g. thoracotomy, pericardiotomy, cardiac massage), performed in the first hour of patient arrival, we identified ERT patients in the 2010-2016 TQIP database. Univariate then backward stepwise multivariable logistic regression analyses were performed to assess independent predictors of mortality. Multiple Imputations by Chained Equations were performed as additional sensitivity analyses.
Results:
Out of 1,403,470 patients, 2,012 patients were included. The median age was 32, 84.0% were male, 66.7% had penetrating trauma, and 87.5% presented with signs of life (SOL). The survival rates were 26.0% in penetrating and 7.6% in blunt trauma. Independent predictors of mortality were age ≥60 [OR=2.71 (1.26-5.82), P=0.011], blunt trauma [OR=4.03 (2.72-5.98), P<0.001], pre-hospital pulse <60 bpm [OR=3.43 (1.73-6.79), P<0.001], ED pulse <60 bpm [OR=4.70 (2.47-8.94), P<0.001], and no SOL [OR=3.64 (1.08-12.24), P=0.037]. ERT had the highest survival rates in penetrating trauma patients <60 who present with SOL. None of the patients with blunt trauma who presented with no SOL survived [Figure 1].
Conclusion:
The survival rates of ERT patients in recent years are higher than classically reported, even in the blunt trauma patient. However, ERT remains futile in patients with a blunt trauma presenting with no SOL. 
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