Are We Out of the Woods Yet? The Aftermath of Resuscitative Thoracotomy
| Autor: | Chad T. Wilson, Jamie L. Fitch, S. Rob Todd, Michelle K. McNutt, C. Cody Miller, D'Arcy J. Wainwright, Joshua A. Villarreal, Sean Dieffenbaugher |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male Patient Transfer medicine.medical_specialty medicine.medical_treatment Resuscitation Wounds Penetrating Wounds Nonpenetrating Rehabilitation Centers law.invention 03 medical and health sciences Young Adult 0302 clinical medicine Blunt Injury Severity Score Postoperative Complications Trauma Centers law Medicine Humans Hospital Mortality Prospective Studies Prospective cohort study Retrospective Studies Rehabilitation Resuscitative thoracotomy business.industry Retrospective cohort study Length of Stay Middle Aged Intensive care unit Patient Discharge Heart Arrest Intensive Care Units Treatment Outcome Thoracotomy Blunt trauma 030220 oncology & carcinogenesis Emergency medicine 030211 gastroenterology & hepatology Surgery Female business |
| Zdroj: | The Journal of surgical research. 245 |
| ISSN: | 1095-8673 |
| Popis: | Background After traumatic arrest, resuscitative thoracotomy is lifesaving in appropriately selected patients, yet data are limited regarding hospital course after intensive care unit (ICU) admission. The objective of this study was to describe the natural history of resuscitative thoracotomy survivors admitted to the ICU. Materials and methods We conducted a retrospective review (January 1, 2012–June 30, 2017) of all adult trauma patients who underwent resuscitative thoracotomy after traumatic arrest at two adult level 1 trauma centers. Data evaluated include demographics, injury characteristics, hospital course, and outcome. Results Over 66 mo, there were 52,624 trauma activations. Two hundred ninety-eight patients underwent resuscitative thoracotomy and 96 (32%) survived to ICU admission. At ICU admission, mean age was 35.8 ± 14.5 y, 79 (82%) were male, 36 (38%) sustained blunt trauma, and the mean injury severity score was 32.3 ± 13.7. Eight blunt and 20 penetrating patients (22% and 34% of ICU admissions, respectively) survived to discharge. 67% of deaths in the ICU occurred within the first 24 h, whereas 90% of those alive at day 21 survived to discharge. For the 28 survivors, mean ICU length of stay was 24.1 ± 17.9 d and mean hospital length of stay was 43.9 ± 32.1 d. Survivors averaged 1.9 ± 1.5 complications. Twenty-four patients (86% of hospital survivors) went home or to a rehabilitation center. Conclusions After resuscitative thoracotomy and subsequent ICU admission, 29% of patients survived to hospital discharge. Complications and a long hospital stay should be expected, but the functional outcome for survivors is not as bleak as previously reported. |
| Databáze: | OpenAIRE |
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