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Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center

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European Journal of Trauma and Emergency Surgery Aims and scope Submit manuscript



To investigate survival after emergency department thoracotomy (EDT) in a physician-staffed emergency medicine system.


This single-center retrospective study included all in extremis trauma patients who underwent EDT between 2013 and 2021 in a military level 1 trauma center. CPR time exceeding 15 minutes for penetrating trauma of 10 minutes for blunt trauma, and identified head injury were the exclusion criteria.


Thirty patients (73% male, 22/30) with a median age of 42 y/o [27–64], who presented mostly with polytrauma (60%, 18/30), blunt trauma (60%, 18/30), and severe chest trauma with a median AIS of 4 3–5 underwent EDT. Mean prehospital time was 58 min (4–73). On admission, the mean ISS was 41 29–50, and 53% (16/30) of patients had lost all signs of life (SOL) before EDT. On initial work-up, Hb was 9.6 g/dL [7.0–11.1], INR was 2.5 [1.7–3.2], pH was 7.0 [6.8–7.1], and lactate level was 11.1 [7.0–13.1] mmol/L. Survival rates at 24 h and 90 days after penetrating versus blunt trauma were 58 and 41% versus 16 and 6%, respectively. If SOL were present initially, these values were 100 and 80% versus 22 and 11%.


Among in extremis patients supported in a physician-staffed emergency medicine system, implementation of a trauma protocol with EDT resulted in overall survival rates of 33% at 24 h and 20% at 90 days. Best survival was observed for penetrating trauma or in the presence of SOL on admission.

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Fig. 1

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Arterial blood gas


Advanced course for deployment surgery


Abbreviated injury scale


Blood pressure


Cardiopulmonary resuscitation


Emergency room


Emergency department thoracotomy


Focused assessment with sonography in trauma


Fresh-frozen plasma


French lyophilized plasma


Glasgow outcome scale


Extended Glasgow outcome scale


Heart rate


Intensive-care unit


Interquartile range


Location of major injury


Mechanism of injury


National trauma databank


Packed red blood cell


Resuscitative endovascular balloon occlusion of the aorta


Systolic blood pressure


Signs of life


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Correspondence to Henri de Lesquen.

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The authors do not have any conflicts of interest related to this manuscript.

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Our prospective registry of severe trauma patients has been registered by the Commission. Nationale de l'Informatique et des Libertés (CNIL) under number 2002878v0 reports anonymised information. This research study was conducted retrospectively from data obtained for clinical purposes. Ethical approval was waived by the local Ethics Committee and the French Society for Thoracic and Cardiovascular Surgery (FSTCVS) under registration number 2019–18 in view of the retrospective nature of the study and all the procedures being performed as part of routine care. This research has been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Specific national laws have also been observed.

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de Malleray, H., Cardinale, M., Avaro, JP. et al. Emergency department thoracotomy in a physician-staffed trauma system: the experience of a French Military level-1 trauma center. Eur J Trauma Emerg Surg 48, 4631–4638 (2022).

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