Too quick to cut? Critical outcomes, resource utilization, and ethical perspectives with a liberal approach to emergency department thoracotomy.

Recent guidelines discourage liberal utilization of ED thoracotomy(EDT), though proponents cite additional considerations (ex. training, ethics, organ donation). We examined these factors at a center with a liberal EDT policy through a mixed-methods study including an eight-year retrospective review and provider survey. Among 428 patients who underwent EDT, six groups were defined by mechanism, injury location and signs of life (SOL). Survival was highest in penetrating thoracic with SOL(8.3 ​%) and lowest in penetrating extrathoracic or blunt without SOL(0 ​%). ROSC was frequent across groups. Organ referral occurred in 79 ​%, yet only 1 ​% became donors(13 organs), all from blunt injury largely without SOL. Blood-product utilization was highest in penetrating thoracic and blunt with SOL. Surveys showed low support of EDT for teaching or blunt trauma without SOL, though nearly half supported for donation. Occupational exposure occurred in 17 ​%, with 50 ​% requiring prophylaxis. Ethical and practical guidance is needed to refine EDT utilization.