ECMO-/ECLS

The role of emergent thoracotomy in the pediatric population remains
unclear. Prior to 1990, the survival of pediatric trauma patients after an
emergent thoracotomy ranged from 0% to 4%. Over the past two decades,
only two retrospective studies have since examined the role of emergency
room thoracotomy in children. A total of 34 patients were reviewed and only 3
patients (10%) suffering penetration injuries survived. No children who suffered
blunt injury and underwent emergent thoracotomy survived in these studies.
Despite significant improvements in pre-hospital trauma care by emergency
medical response teams and the development of specialized pediatric trauma
centers, pediatric survival rates after emergent thoracotomy remain
concerningly low.
Unfortunately, the infrequency of this procedure in children limits
sufficient data to draw definitive conclusions. The paucity of information
regarding emergent thoracotomy in children is likely due to the fact that children
rarely have cardiac arrest after trauma. Penetration injury in children, in
particular, is extremely rare. Furthermore, when patients do present with
sufficient indications for thoracotomy, the procedure may not be performed due
to either lack of evidenced based data regarding utility of the procedure in
children, or providers may lack appropriate surgical experience to perform the
procedure.
Although the pediatric literature demonstrates low survival rates after
emergent pediatric thoracotomy, it should still be considered as there are no
other alternative to death in these patients with critical injuries. Currently,