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Analysis of 164 percutaneous chest tube thoracostomies performed as a standardized technical procedure in the management of 129 blunt trauma victims demonstrated an overall complication rate of 9.1% (15 of 164). Three complications (1.8%) were related to problems of insertion, and four (2.4%) represented the problem of pneumothorax after chest tube removal. The remaining eight complications (4.9%) were associated with positive bacterial cultures, two (1.2%) of which represented clinical empyema. Both cases of empyema had either prolonged chest tube placement (23 and 15 days) or multiple chest tubes (two and three) on the same side. Percutaneous chest tube thoracostomy remains an important facet in the management of certain types of blunt thoracic trauma. Associated risks can best be minimized with adherence to a standardized technique and management protocol.

Catheter aspiration for simple pneumothorax (CASP) was evaluated prospectively in the outpatient management of simple traumatic pneumothorax in 17 patients and compared to conventional tube thoracostomy (CTT) in 17 matched control patients. In 16 of the 17 consecutive study patients CASP maintained lung reexpansion without complications. Pneumothorax was due to needle puncture for drug abuse in 11 patients, stab wounds in five patients, and blunt trauma in one patient. The CASP patients were not hospitalized, whereas the control CTT patients averaged 4.9 days' hospitalization. CTT was associated with complications in two patients versus none for CASP. Parenteral analgesics were utilized for greater than 48 hours in CTT patients but were not needed for CASP patients. Costs averaged +310 for CASP compared to +3,030 for CTT. This ongoing pilot study data indicates that CASP is a reasonable alternative to CTT in selected patients with simple traumatic pneumothorax.

This study group comprises 73 patients who underwent emergency room resuscitative thoracotomy for cardiac arrest following penetrating chest and neck injuries. Overall, 12 patients (16.4%) were successfully resuscitated but only five (6.8%) left the hospital alive without neurologic defects. None of the 18 cases with no vital signs at all (no cardiac activity, no respiratory efforts, nonreactive pupils) on admission survived. Only one out of the 19 cases with no cardiac activity and with fixed pupils but present respiratory efforts survived (5.3%). Of 14 patients with cardiac arrest but with respiratory efforts and reactive pupils, three survived (21.4%). We suggest that patients with no vital signs on admission to the hospital should not be subjected to resuscitative thoracotomy.

Emergency thoracotomy is required in 10-15 per cent of all patients with thoracic injury. Nine specific indications for emergency thoracotomy have been described for injured persons. A variety of incisions is available to the surgeon, and selection of the appropriate incision is based on radiographic and clinical findings. Thoracotomy in the emergency room is occasionally indicated, but it should be performed only by surgically trained individuals. Patients requiring emergency thoracotomy who are not dead on arrival have a greater than 75 per cent chance of survival.