Hemodynamic variables predict outcome of emergency thoracotomy in the pediatric trauma population

Background

Limited data exist regarding indications for resuscitative emergency thoracotomy (ETR) in the pediatric population. We attempt to define the presenting hemodynamic parameters that predict survival for pediatric patients undergoing ETR.

Methods

We reviewed all pediatric patients (age < 18 years), entered into the National Trauma Data Bank from 2007 to 2010, who underwent ETR within one hour of ED arrival. Mechanism of injury and hemodynamics were analyzed using Chi squared and Wilcoxon tests.

Results

316 children (70 blunt, 240 penetrating) underwent ETR, 31% (98/316) survived to discharge. Less than 5% of patients survived when presenting SBP was ≤ 50 mmHg or heart rate was ≤ 70 bpm. For blunt injuries there were no survivors with a pulse ≤ 80 bpm or SBP ≤ 60 mmHg. When survivors were compared to nonsurvivors, blood pressure, pulse, and injury type were statistically significant when treated as independent variables and in a logistic regression model.

Conclusions

When ETR was performed for SBP ≤ 50 mmHg or for heart rate ≤ 70 bpm less than 5% of patients survived. There were no survivors of blunt trauma when SBP was ≤ 60 mmHg or pulse was ≤ 80 bpm. This review suggests that ETR may have limited benefit in these patients.