J Acute Care Surg.  2020 Nov;10(3):112-117. 10.17479/jacs.2020.10.3.112.

Emergency Department Laparotomy Can Be a Resuscitative Option for Patient with Cardiac Arrest and Impending Arrest due to Intra-Abdominal Hemorrhage

• Park CI
• Kim JH
• Lee KH
• Ryu DY
• Sun HW
• Kim GH
• Lee SB
• Park SJ
• Kim H
• Yeom SR

• KMID: 2512849
• DOI: http://doi.org/10.17479/jacs.2020.10.3.112

Abstract

Purpose
Managing patients with hemorrhagic shock is mainly dependent on stopping the bleeding as fast as possible. Emergency Department laparotomy (EDL) is considered one of the approaches to control intra-abdominal bleeding rapidly. This study aims to evaluate the outcomes of EDL in a regional trauma center of Pusan National University Hospital in a 4-year period.
Methods
The medical records and data of patients who underwent EDL from January 2016 to December 2019 were analyzed. Patients who underwent preperitoneal pelvic packing only or did not receive surgery immediately after EDL were excluded.
Results
Twenty-four patients who underwent EDL were included in the study. 18 patients had sustained blunt trauma, and 6 suffered from penetrating injuries. Small bowel mesentery and liver injuries were the most frequent. Increase of median systolic blood pressure (SBP) after EDL was 55.5 mmHg. Four (16.7%) out of the 24 survived; one of the four survivors received cardiopulmonary resuscitation (CPR). In the nonsurvivor group, Injury Severity Score was significantly higher (p = 0.013), initial pH was lower (p = 0.035) and the amount of packed red blood cells transfusion after EDL was significantly higher (p = 0.013) than those in the survivor group.
Conclusion
The mortality rate was very high in trauma patients who were required EDL. Although EDL was not proved to be an effective procedure for resuscitation in trauma patients, it could be considered as one of the treatment options for trauma patients in extremis. Further studies are required to examine the effects of EDL.

Keyword

emergency department; laparotomy; hemorrhage; resuscitation