744 Indications for Emergency Department Resuscitative Thoracotomy in Blunt and Penetrating Trauma: A Survey of UK Major Trauma Centre Guidelines. (19th August 2022)

• Record Type: Journal Article
• Authors: Oliver, M; Bennet, J; Nassr, N; Marson, B; Freij, R; Brooks, A
• Is Part Of: British journal of surgery. Volume 109(2022)Supplement 6
• Publication Date: 2022-08-19
• Subjects: Surgery -- Periodicals; 617.005
• DOI: 10.1093/bjs/znac269.209
• Languages: English
• ISSNs: 0007-1323

Abstract

Abstract: Aim: Traumatic Cardiac Arrest (TCA) is a potentially fatal consequence of penetrating or blunt trauma. Emergency-Department Resuscitative Thoracotomy (ED-RT) is the last resort procedure to restore cardiac output following TCA. This study reviews current UK guidelines of Major Trauma Centres (MTCs) to identify common indications for ED-RT and chest compressions following TCA. Method: Departmental policies were requested from all UK MTCs. Data was extracted by three reviewers. A planned subgroup analysis was performed for blunt/penetrating trauma. Results: 20 guidelines were identified covering 22 MTCs. All guidelines included recommendations regarding indications for ED-RT. Time thresholds from loss of output to undertaking RT in blunt trauma were given in 12 (60%) guidelines. Ranging from 5 (25%), 10 (50%) and 15 minutes (10%). Prehospital loss of output was a contraindication for blunt trauma ED-RT in 6 guidelines. ED-RT in penetrating trauma was indicated within 10 (50%) or 15 minutes (45%) from loss of output. Fewer than 50% of guidelines identified specific contra-indications including massive head injury and asystole. 3 guidelines stated chest compressions were not indicated in TCA. 8 stated that chest compressions may not be contra-indicated and 1 advised chest compressions to be restricted to blunt trauma. Conclusion: In a survey of UK guidelines, we have found inconsistency in the indications for ED-RT, particularly associated with blunt trauma. A maximum time from loss of output to ED-RT for penetrating trauma of 15 minutes is compatible with most guidelines. This is less consistent with findings for blunt trauma. There is little consensus regarding use of chest compressions.