1131 A Series of Three Consecutive Emergency Room Thoracotomies Performed Within a Period of One Month at the National Accident and Orthopaedics Services Department in Sri Lanka

Introduction Emergency room thoracotomy is an essential component of initial resuscitation in a proportion of patients who present following thoracic injuries. Case Presentations A 51-year-old male, hospitalised within 45 minutes following a stab injury to posterior chest, went to asystolic cardiac arrest on admission. Emergency left antero-lateral thoracotomy was performed at 6minutes post arrest. It revealed massive hemothorax (3L), and active bleeding from intercostal vessels. Internal Cardiac Massage (ICM) with Aortic Cross Clamping(ACC) commenced and haemostasis achieved. Return of spontaneous circulation(ROSC) gained within 2minutes. He was extubated on day1 and discharged on day 8. A 19-year-old male was transferred from a local hospital 4hours following road traffic accident(RTA) with poly-trauma to head, face, chest and abdomen. He went to asystolic cardiac arrest at 20minutes post admission. Left antero-lateral thoracotomy performed at 2minutes post arrest revealed, hemopericardium and left ventricular wall partial-thickness tear. ICM with ACC started and hemopericardium was released. ROSC achieved within 2minutes. Patient was immediately taken for exploratory thoracotomy and ventricular wall repair. After a brief stable post operative period, patient gradually deteriorated and passed away on day3 due to traumatic brain injury and diffuse axonal damage. A 59-year-old male, hospitalised 30minute following RTA (with direct chest impact) was in asystole on admission. Emergency transverse thoracotomy performed at 15minutes of resuscitation revealed multiple lung contusions and bilateral hemothorax. ICM with ACC started but failed to achieve ROSC at 20minutes. Conclusions Shorter the time gap from asystole to thoracotomy, higher the probability of ROSC.