THRESHOLD OF HOPE: RETHINKING RESUSCITATIVE THORACOTOMY IN THE ELDERLY icvaz787@gmail.com

 

THRESHOLD OF HOPE: RETHINKING RESUSCITATIVE THORACOTOMY IN THE ELDERLY

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United States

Oral or Poster

Emergency department thoracotomy (EDT) is a last-resort resuscitative measure in trauma, but its efficacy in elderly patients remains controversial. With the growing geriatric trauma population (projected to exceed 94 million by 2060), defining appropriate resuscitation limits is essential. While overall EDT survival is reported at 7.4%, outcomes in elderly patients ≥70 years remain understudied. This study evaluates mortality and resource utilization in elderly patients undergoing EDT.

A 10-year retrospective cohort study using a multi-institutional trauma registry was conducted. Patients were stratified into two cohorts: <70 and ≥70 years. Primary outcomes included in-hospital mortality, blood product utilization, and discharge disposition. Multivariable regression models adjusted for injury severity, mechanism, and comorbidities.

Of 578 patients, 69 (12%) were >70 years old with a mortality rate of 94.2% (n=65) vs. 91.8% in ≤70 patients (p=0.68). Survival did not differ by mechanism. Mortality increased with lower trauma center level (Level I: 89.1%, Level II: 92.8%, Level III/IV: 97.1%). Elderly patients had higher fresh frozen plasma use (9.2±11.5 vs. 2.5±3.4 units, p=0.03), with similar red blood cell transfusion rates. Despite aggressive resuscitation, survival to rehab discharge was 50% (2/4 patients).

Age alone should not preclude EDT, as survival outcomes were comparable. However, elderly patients had notably higher resource utilization. These findings highlight the need to reassess its role in geriatric trauma, ensuring patient-centered, resource-conscious care. Given the limited survival benefit, ethical considerations regarding patient autonomy, quality of life, and appropriate resource allocation must be integrated into decision-making. Indications for EDT in this population should be individualized.