Introduction
Emergency Department Thoracotomy (EDT) is a common medical procedure for saving the life of a patient who has had a chest injury (Cardiothoracic trauma). While some studies show that most EDT patients have a survival rate of more than 50%, others believe that this percentage is lower (Chalkias, 2012). The latter group also believes that the procedure is futile because it puts health care service providers at risk of contracting diseases (Seamon, Chovanes, Fox, and Green, 2012). These facts show that EDT is a controversial and divisive medical procedure. However, regardless of the debates surrounding it, the procedure remains a potentially life-saving one. To have a broader understanding of EDT, this paper describes and explores different statistics and risks surrounding the procedure.
Description
EDT is a leading cause of death for many patients that suffer traumatic injuries. Seamon et al. (2012) say it accounts for up to 50% of all deaths caused by cardiothoracic trauma. Many patients who suffer thoracic injuries do not need EDT, but when their conditions deteriorate, in the emergency room, or during pre-emergency care, doctors may have to conduct the procedure. Experts have disagreed on the best time to conduct an EDT (Chalkias, 2012). Furthermore, they disagree on whether the procedure is useful, or not. These sentiments emerge from the views of some researchers who believe that most patients of EDT have a low survival rate (Chalkias, 2012). Comparatively, others believe the survival rate of EDT patients is higher. Nonetheless, it is important to understand that health care practitioners conduct EDT to control hemorrhage, to release cardiac tamponade, to open cardiac massage, to treat air embolus, and to cross-clamp descending thoracic aorta.
Survival Rates
Factors that Determine Survival Rates
Broadly, Thomas & Ogunleye (2012) say the survival rate for EDT patients often varies between 4% and 33%. This variation mainly comes from different factors, such as the type of injury, location of injury, and the stability of vital organ functions, as shown below.
Type of Injury
Patients suffering from penetrative thoracic injuries often have a higher survival rate than if they suffered other types of thoracic injuries. Relative to this assertion, Thomas and Ogunleye (2012) say this group of patients has a uniform survival rate (between 18% and 33%). Studies have also shown that stab wound victims have a higher survival rate than victims of gunshot wounds. However, gunshot victims that have injuries on multiple heart chambers have a lower survival rate. Comparatively, patients with stab wounds, which have caused cardiac tamponade, have the highest survival rates. Thomas & Ogunleye (2012) say that their survival rates may reach 70%.
Besides gunshot wounds and cut wounds, researchers have also investigated the mortality rates of EDT patients who have suffered from blunt trauma. For example, statistics from the Trauma Committee of the American College of Surgeons say that most victims of blunt trauma have a survival rate of 1.6% (Khorsandia, Skourasb & Shah, 2013). Comparatively, a different set of studies, which sampled about 1,050 patients in America, showed that most patients who suffer from blunt trauma have a survival rate of about 1.4%. About 11 researches (from the above group of studies) showed lower survival rates (below 1.4%) (Khorsandia et al., 2013). Only one study reported a high survival rate of about 13%. Some medical researchers believe this figure is higher, but since some of their findings affirm possibilities of more health complications among this group of patients, they cannot authoritatively say that EDT is effective. For example, Khorsandia et al. (2013) examined a past study and reported that 15% of patients who suffered from blunt trauma and received EDT also suffered neurological sequelae. Overall, regardless of the differing views surrounding the above findings, many studies show a low survival rate for EDT among patients who have suffered blunt trauma. Furthermore, there are high numbers of patients who have developed neurological sequelae from the process.
Based on the above findings, some researchers propose that health care practitioners could increase the survival rates of blunt trauma patients if they contraindicate EDT (Khorsandia et al., 2013). This recommendation mainly applies to patients who have no sign of life. Comparatively, some experts recommend that, because of the low survival rates of blunt trauma patients, doctors should abandon EDT altogether. However, Thomas & Ogunleye (2012) disagree with this analogy by saying that this recommendation oversimplifies the findings. Instead, they believe that some isolated blunt thoracic traumas have a high survival rate. Particularly, they draw our attention to the relatively high survival rates for patients who are severely hypotensive. Based on the same analogy, Thomas & Ogunleye (2012) recommend that most patients, who suffer from blunt thoracic trauma (causing traumatic arrest), should also undergo EDT.
Location of Injury
The nature of injury often determines a patient’s survival rate. For example, this paper already shows that most patients who suffer from multiple chamber heart injuries have a lower survival rate than those who suffer injuries to one chamber of the heart. Similarly, if an injury affects a major blood vessel, the patient would have a low survival rate. Comparatively, patients who suffer from injuries that affect the thoracic wall have a higher survival rate. These findings show that the type of injury affects mortality rates in EDT.
Presence of Vital Signs
Vital signs often affect the success rates of EDT. For example, the presence of cardiac activity during emergency treatment could decrease mortality rates. However, if there is a loss of cardiac activity, the time lag between the loss of the activity and the emergency treatment may influence the outcome of EDT. For example, researchers have recorded the highest survival rates of EDT among patients who receive treatment at the emergency department (as opposed to receiving treatment in an ambulance) (Khorsandia et al., 2013). Comparatively, the lowest survival rates for patients with blunt traumas occur when they have no signs of life. Overall, these statistics show that mortality rates decrease with a decreased presence of vital signs.
EDT Risks
Seamon, Chovanes, Fox, and Green (2012) say EDT risks are twofold. First, they come from increased health risks for physicians because of the exposure to blood-borne pathogens. To affirm this risk, Seamon et al. (2012, p. 1359) say EDT may expose physicians to HIV and hepatitis infections. Relative to this assertion, Seamon et al. (2012) say physicians have a 1.3% chance of contracting the HIV virus and a 0.6% chance of contracting the hepatitis virus. While the incidences of HIV infections through cut exposures are low (in some types of EDTs), the risks of hepatitis transmissions are high (Seamon et al., 2012). Therefore, physicians stand a high risk of contracting diseases from EDT. Secondly, EDT risks come from the inefficient use of hospital resources, police facilities, and emergency services. While death (as a risk) is unquantifiable, several research studies have given varied figures of EDT financial risks (Seamon et al., 2012). Estimates show that the costs of EDT are up to $7,200. Comparatively, patient costs are between $13,674 and $140,000 (Seamon et al., 2012). These variations depend on demographic patterns, practice patterns, and analytical methods used by health practitioners. Lastly, besides health risks and financial costs, Seamon et al. (2012, p. 1359) say EDT procedures often compromise human dignity.
Summary
This paper shows that EDT is a controversial procedure because of varied success levels and increases health risks for patients and physicians. However, different factors affect its successes and failures. For example, this paper shows that mechanisms of injury, presence of vital signs, and types of injuries affect the survival rates of EDT patients. Therefore, depending on these factors, the mortality rates of EDT patients vary. The risks posed by the procedure mainly decrease survival rates, but to make it safe for physicians, health care facilities should protect their employees from the potential health risks associated with the procedure. Similarly, since EDT could affect a patient, it is important for physicians to know when to use it, after factoring in all essential information about the procedure. Stated differently, they should consider different aspects of EDT that affect patients’ survival rates.
References
Chalkias, A. (2012). Prehospital Emergency Thoracotomy: when to do it? Australasian Journal of Paramedicine, 7(4), 1-10.
Khorsandia, M., Skourasb, M., & Shah, R., (2013). Is There Any Role For Resuscitative Emergency Department Thoracotomy in Blunt Trauma? Interact CardioVasc Thorac Surg, 16(4), 509-516.
Seamon, M., Chovanes, J., Fox, N., & Green, R. (2012). The Use of Emergency Department Thoracotomy for Traumatic Cardiopulmonary Arrest. Injury, Int. J. Care Injured, 43(1), 1355–1361.
Thomas, M., & Ogunleye, E. (2012). Emergency Thoracotomy: Indications and Management Challenges in a Developing World. World Journal of Cardiovascular Surgery, 2(1), 1-4.