Emergency Department Thoracotomy

This emergent procedure is performed in the Trauma Resuscitation Area or ED to urgently revive patients who have just sustained or are on the verge of cardiac arrest.  A left-sided anterolateral thoracotomy is performed at approximately the 5^th intercostal space, extended from the sternum to as posterior as possible.  This maneuver allows for a pericardectomy under direct visualization to decompress cardiac tamponade, temporary repair of penetrating myocardial wounds, cross-clamping of the descending aorta thus preventing ongoing distal bleeding while perfusing the brain and heart, and open cardiac massage.  Practice Management Guidelines published by the American College of Surgeons Committee on Trauma (ACS-COT) include the following recommendations.

1. This is best applied to patients sustaining penetrating cardiac injuries who arrive at trauma centers after a short scene and transport time (15 minutes or less) with witnessed or objectively measured physiologic parameters showing signs of life.

2. It should be performed in patients sustaining penetrating noncardiac thoracic injuries.

3. This maneuver should be performed rarely in the patient sustaining cardiopulmonary arrest secondary to blunt trauma because of its very low survival rate and poor neurologic outcomes. It should only be performed after a witnessed loss of vital signs and cardiac arrest.

4. It should be performed in patients sustaining exsanguinating abdominal vascular injuries.

thanks to Dr. Keith Hood for this submission