Emergency Department Thoracotomy: Indications and Outcomes

Abstract

The indications for Emergency Department Thoracotomy (EDT) continue to be debated. By definition, EDT refers to thoracotomy performed outside of an operating room, performed on patients who arrest prior to or shortly after arrival. Many papers include patients who arrest after arrival and after significant interventions (intubation, central access etc) and this tends to confuse the data. While recognizing that a small select number of patients may benefit, EDT continues to be performed because of emotional pressure to “do something”, because of desire to gain experience, and because there is a reaction to using “cost-benefit” analyses to patients whose only alternative is death. However these cost issues, coupled with real concern regarding wasting valuable resources as well as exposure of caregivers to viral pathogens continue to stimulate reappraisal. Because the actual techniques of thoracotomy are described elsewhere, this chapter will focus on indications for and outcome of EDT.