Risk of Emergent Thoracotomy

August 10, 2018

Written by Clay Smith

Spoon Feed
ED thoracotomy (EDT) was associated with a risk of exposure to blood or body fluid in 7.6% of the 305 cases and 1.6% of the 1360 participants.

Why does this matter?
EDT may be lifesaving but not often.  It is also associated with risk, namely occupational exposure to potentially infectious body fluid.  What is that risk specifically?

Let’s be careful out there…
This was a prospective study of 1360 surgeons performing 305 EDTs to determine the rate of accidental exposure to blood or body fluid.  Of the EDTs, 15 patients survived, 13 neurologically intact.  There were 22 exposures, mostly needlesticks.  This meant 7.6% of all EDTs were associated with an exposure and 1.6% of all participants had an exposure performing EDT.  Compliance with full personal protective equipment was only 46% among exposed providers.  Although the risk of exposure is low for an individual, this should factor into the decision to perform EDT.  The chance of surviving EDT is very low; in some cases we know EDT is futile, such as: CPR > 10 minutes, penetrating trauma patients with CPR > 15 minutes, or asystole without (clinical) tamponade.  I would add as well that bedside ultrasound with no pericardial fluid and no cardiac activity also means EDT is futile.

Source
Occupational exposure during emergency department thoracotomy: A prospective, multi-institution study.  J Trauma Acute Care Surg. 2018 Jul;85(1):78-84. doi: 10.1097/TA.0000000000001940.
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Another Spoonful
See what the Trauma Pro says.  Here’s a taste, “How can anyone justify not wearing full PPE during an emergency thoracotomy?”

Reviewed by Thomas Davis