Provision of Cardiothoracic Surgical Cover for Trauma
15 November 2021
Introduction
The reconfiguration of trauma management with the institution in 2010 of trauma networks and trauma units feeding in to major trauma centres (MTC)1 has led to improvement in mortality2 . Cardiothoracic units have had to adapt without any recent national guidance or support.
A recent audit of cardiothoracic trauma in a major UK trauma centre showed that the vast majority of patients sustaining a cardiothoracic injury do not need the involvement of a cardiothoracic surgeon. Most patients can be managed, at least initially, either conservatively or with a chest drain under the care of trauma surgeons. A small minority will require subsequent urgent operative intervention by a cardiac or thoracic surgeon3 .
A separate audit of the current provision of cardiothoracic care for trauma in the UK has shown a variety of models that all appear to be effective and address local demand, with assistance to first line trauma surgeons provided by either a cardiac or thoracic surgeon, or both.
It is not always possible for cardiac, thoracic or cardiothoracic surgeons to be available for salvage life-saving operations in the resuscitation rooms of the major trauma centres. This is for two reasons:
1. It is not feasible to have a senior cardiothoracic surgeon resident 24 hours a day, 7 days a week available for the resuscitation room with the necessary theatre team and cardiopulmonary bypass equipment;
2. It is not practical to expect cardiothoracic surgeons to be able to get to the resuscitation room in a timely and reliable manner due to variations in geography and co-location with the major trauma centre.
Life-saving salvage surgery in the resuscitation room needs to be performed by the trauma team. They will need to perform the emergency incision and control life threatening haemorrhage and / or relieve cardiac tamponade. Cardiothoracic surgeons will be simultaneously called to take over the management of the patient for restorative surgery, either in the resuscitation room or transferred to a cardiothoracic theatre (with or without the necessary imaging).
Cardiothoracic surgeons are able to help train and educate trauma teams to perform the necessary incisions and initial procedures in salvage surgery
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