Pediatric Surgery International
Survival after emergency department thoracotomy in the pediatric
trauma population: a review of published data
Eliza E. Moskowitz
· Clay Cothren Burlew
· Ann M. Kulungowski
· Denis D. Bensard
Accepted: 23 May 2018
© Springer-Verlag GmbH Germany, part of Springer Nature 2018
Background/purpose The utility of EDT in the adult trauma population, using well-deﬁned guidelines, is well established,
especially for penetrating injuries. Since the introduction of these guidelines, reports on the use of EDT for pediatric trauma
have been published, and these series reveal a dismal, almost universally fatal, outcome for EDT following blunt trauma in
the child. This report reviews the clinical outcomes of EDT in the pediatric population.
Materials/methods We performed a review of EDT in the pediatric population using the published data from 1980 to 2017.
Variables extracted included mechanism of injury and mortality. To minimize bias, single case reports were not included
in the review.
Results Upon review of four decades of published literature on the use of emergency department thoracotomy (EDT) in the
pediatric population, mortality rates are comparable between adults and pediatric patients for penetrating thoracic trauma.
In contrast, in pediatric patients sustaining blunt trauma, no patient under the age of 15 has survived.
Conclusion In patients between 0 and 14 years of age presenting with no signs of life following blunt trauma, withholding
EDT should be considered. Patients between the ages of 15 and 18 should be treated in accordance with adult ATLS prin-
ciples for the management of thoracic trauma.
Level of evidence Level IV
Keywords Emergency department thoracotomy · Pediatric · Resuscitative thoracotomy · Cardiac arrest · Children ·
The injured pediatric patient presenting in extremis poses
clinical and ethical dilemmas for the trauma surgeon.
Emergency department thoracotomy (EDT) is an integral
component of the initial resuscitation of adult patients pre-
senting with acute traumatic arrest after injury. The ideal
application of EDT necessitates is not only understand-
ing the technical maneuvers but also the physiologic and
metabolic consequences of the procedure. Indications for
emergent thoracotomy have evolved over the course of the
ﬁrst half of the twentieth century with the introduction of
external deﬁbrillation for arrest and pericardiocentesis for
post-injury cardiac tamponade [1–3]. Due to advances in
surgical technique, a rebirth of emergent thoracotomy for
patients in extremis with traumatic chest or abdominal injury
occurred by the 1960s [4–6]. Concurrent with advances in
prehospital resuscitation, the past two decades are marked
by several critical analyses of outcomes in patients who have
undergone EDT [7–13]. This resulted in a more selective and
tempered application of EDT based upon clearly deﬁned
indications rather than an obligatory procedure undertaken
prior to declaration of death.
* Denis D. Bensard
Eliza E. Moskowitz
Clay Cothren Burlew
Ann M. Kulungowski
Department of Surgery, Denver Health Medical Center
and the University of Colorado School of Medicine, Denver,
Department of Surgery, University of Colorado, 12631
E. 17th Ave., C302, Aurora, CO 80045, USA