BACKGROUND: This study was designed to reassess the indications for TR in our institution. METHODS: A retrospective study of 126 patients undergoing TR from January 1995 to December 2004 was performed. Four groups were defined based on the severity of their injuries: death on arrival, fatal, agonal and profound shock. Database included variables such as mechanism of trauma, vital signs, Revised Trauma Score (RTS), sites of injury (identified during surgery or autopsy), Injury Severity Score (ISS) and survival. RESULTS: The mechanism of injury was gunshot wound in 72 (57,2%) patients, stab wound in 11 (8,7%) and blunt trauma in 43 (34,1%). Sixty patients (47,6%) had no vital signs (death or fatal groups) on admission at the Emergency Department (ED); although none of them survived, 13 (39,4%) fatal patients survived to reach the operating room (OR). In the agonal and profound shock groups (66 patients), 44 (66,7%) had TR in the ED and 31 (70,5%) reached the OR. In the remaining 22, cardiorespiratory arrest occurred in the OR, where the TR was performed. Two patients in profound shock survived (1,6% of the total) and were discharged with normal neurologic function. The ISS average was 33 and exsanguination was the most frequent cause of death. CONCLUSION: Our results indicate poor outcome and further emphasizes the need for a more selective approach in the application of TR. An algorithm based on mechanism of injury and vital signs on admission at ED is proposed to optimize the indications of TR.
Thoracotomy; Cardiopulmonary resuscitation; Heart massage; Thoracic injuries
