Outcomes of emergency resuscitative thoracotomies in a trauma unit in Johannesburg, South Africa

Abstract

Background. Emergency resuscitative thoracotomies (ERTs) are life-saving procedures for traumatic cardiac arrest or severe haemorrhage, but their outcomes remain variable and are influenced by several factors, including timing, mechanism of injury and the presence of initial signs of life. Studies on ERT outcomes predominantly originate from well-resourced settings, leaving a gap in understanding their effectiveness in resource-constrained environments. Objective. To conduct a prospective audit of ERTs performed at a level 1 trauma unit over a 1-year period (1 April 2023 - 31 March 2024), assessing initial presentation characteristics, indications for ERT and subsequent outcomes in terms of survival and complications. Methods. A prospective analysis of 19 consecutive patients who underwent ERT was performed. Data included demographics, mechanism of injury, initial physiological parameters, ERT indications, resuscitation times, blood product transfusions, complications and survival to discharge. Results. The study comprised predominantly male patients (94.74%) with a wide age range (19 - 68 years). Penetrating trauma was the most common mechanism of injury (94.44%). An association was observed between shorter interval between fluid resuscitation time and commencement of ERT time and survival. Elevated lactate levels and acidosis were more frequent in non-survivors. A high mortality rate was noted (only one patient survived). Conclusion. This study did not find statistically significant results, but recognising the importance of prompt and ongoing resuscitation in improving survival after ERT is consistent with existing literature. However, the small sample size significantly limits the ability to apply these findings to other cases. Larger studies are necessary to definitively establish the impact of factors such as resource limitations on ERT outcomes in under-resourced settings. The high mortality rate highlights the need for focused research into improving patient selection criteria, optimising ERT techniques and addressing resource constraints in developing countries.