Date of Award

2023

Document Type

Open Access Thesis

Degree Name

MS in Physician Assistant Studies (PA)

Department

Physician Assistant Studies

First Advisor

Eric Van Hecke, MPAS, PA-C, CAQ-EM, DMSC candidate

Abstract

Emergent thoracic surgery involving the heart has been taking place for 126 years. Thoracic penetrating trauma is occurring more and more frequently in the US, and while 90% of patients with penetrating thoracic trauma die en route to hospital, the ones who arrive in extremis have better chances of survival now than ever due to an improving 60+ year practice of emergency department thoracotomy (EDT). This review has a primary objective of comparing the literature and history of EDT as a lifesaving intervention for patients with penetrating thoracic trauma and resulting mortality. It also aims to give context on EDT as an emergent intervention with respect to the pathophysiology occurring in patients requiring this intervention and how EDT fits in with the rest of the treatment received by trauma patients with severe intrathoracic injuries.

This is a systematic review utilizing keywords: “thoracotomy,” “EDT,” “resuscitation,” “penetrating,” “gsw,” “stab,” “emergency,” “thoracic,” and “injury” to search the databases of PubMed, Google Scholar, and Science Direct.

While EDT remains a procedure with low survival to discharge (5-25%), there are cases which are most favorable to the procedure, namely patients who arrive with SOL, have a single penetrating wound to the heart that is not inflicted by a bullet.

EDT is a tried-and-true method for patients who will not otherwise survive. However; only recently have large meta-analyses been put together because this is a very high risk, and an infrequently performed procedure. There is also call for conservative management and temporizing measures such as REBOA, though there is still no ICD code, and too little research to consider this controversial procedure comparable to EDT.

Identifier

SC 11.PAS.2023.Scherf.S

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