The role of emergency resuscitative thoracotomy in blunt trauma: a systematic review

Poillucci, Gaetano;Fransvea, Pietro;Serao, Angelo;Pronio, Annamaria;Piras, Edoardo;Podda, Mauro;Adami, Ennio A

2025-01-01

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Abstract

INTRODUCTION: Emergency resuscitative thoracotomy (ERT) is a potentially life-saving procedure for selected trauma patients presenting in extremis with pending or already witnessed cardiopulmonary collapse. Outcome mostly in blunt trauma is believed to be poor. Our aim was to identify all studies reported over the past fourteen years and compare reported outcomes for blunt trauma. EVIDENCE ACQUISITION: We performed a systematic literature search according to PRISMA guidelines (from January 1st, 2010 to May 31st, 2024). Qualitative comparison of studies and outcomes was done. EVIDENCE SYNTHESIS: A total of 22 articles were included for an overall number of 6315 ERT for blunt trauma. Male-to-female distribution was 3:1. The collectively reported overall survival was 4.5%. Mean age varied from lowest at 32.4 years to highest at 53 years. Neurological outcome was reported in 6 of 21 studies; among this six publications, just one reported neurological outcome using the Glasgow Outcome Scale (GOS). Heterogeneity in the studies prevented outcome analyses by formal quantitative meta-analysis. CONCLUSIONS: The reported outcome after ERT for blunt trauma is not favorable, with an extremely low survival rate highlighted in most studies. Multicenter, prospective, observational data are needed to validate the modern role of ERT in blunt trauma.