see also: [Robert Hedges Resucitative thoracotomy](x-devonthink-item://31ACDC98-D2CC-48C5-BE69-E9B37E53FA8C?page=416), [Dunn - Resuscitative thoracotomy](x-devonthink-item://177F9BB5-A0E8-48D3-BB4D-D8F114FFEDB1) See: [Pre Hospital Resuscitative Thoracotomy for Traumatic Cardiac Arrest](https://www.stemlynsblog.org/laa-resuscitative-thoracotomy/) - [cubox](cubox://card?id=7298383224412045927) : excellent study essentially showing poor outcomes if exsanguination but better results if traumatic cardiac arrest causes by tamponade #procedures > [!Key Points] potential benefits > - release tension [[pneumothorax]] or cardiac [[tamponade]] > - allow direct control of intrathoracic haemorrhage > - suture/staple cardiac laceration > - allow cross-clamping the descending aorta (in so doing stopping blood loss below the diaphragm and improving brain and cardiac perfusion) > - permit open cardiac compression and defibrillation # Indications - stab wound to heart with pericardial tamponade - **penetrating** chest trauma with signs of life in previous 10 minutes -- 2/3 survive besides for GSW (much lower survival) - clear evidence of pericardial tamponade causing haemodynamic instability from blunt trauma - rarely as a temporising measure to restore cenral circulation in major haemorrhage from other injuries below the diaphragm - if definitive surgery is immediately available - trauma patients severe refractory instability or cardiac arrest - usually penetrating trauma victim in cardiac arrest) - hypothermia (non-traumatic; for re-warming) ## Injuries where this procedure is considered - penetrating cardiac injuries - blunt cardiac injuries - pulmonary injuries (eg massive haemothorax) - air embolism - penetrating abdominal injury # contraindications - asystole on arrival - blunt trauma cardiac arrest with no signs of life prehospital - cardiac arrest/loss of output > 10 or 15 min - obvious non-survivable injuries eg head injuries - no access to definitive surgical interventions - high calibre bullet injuries (Dunn) - blunt trauma without signs of tamponade (Dunn) - multiple wounds (relative contraindication per Dunn) # complications - phrenic nerve injury - coronary artery injury - infection - injury to healthcare worker # Procedure ![[Pasted image 20230618193550.png]] thoracotomy # Related Questions ## penetrating abdominal injury - [ ] 14Q: [Penetrating abdominal injury](x-devonthink-item://1442A590-B32E-40BE-9C29-6401A71DC2DC?page=10) -- [Answer](x-devonthink-item://0C9617AB-8E16-4A75-ADF0-AB06FA726B0A?page=4) - [ ] 15Q: [Penetrating Abdominal Injury](x-devonthink-item://40F10AFA-5F29-4EE4-B149-300627B498B0?page=10) -- [Answer](x-devonthink-item://2088AEED-9FCF-4CF0-B58D-E4279D4BCC76?page=31) ## thoracotomy - [x] DUPLICATE Q: [Traumatic arrest](x-devonthink-item://1A14F7A1-E434-47A6-BC68-AF2DD1A7C090?page=16) -- [Answer](x-devonthink-item://736EC9CD-AC9C-4588-BA1E-F4AD190CBA47?page=38) - [ ] 17Q: [Chest stabbing](x-devonthink-item://2CB6E202-E7C1-46E8-B49F-435AB6C937F0?page=3) -- [Answer](x-devonthink-item://78503782-404C-41A2-A3AE-B1A26F578DF5?page=3) - [ ] 18Q: [Penetrating chest trauma](x-devonthink-item://F0498813-9350-484C-AD5B-6FF7C3AE9015?page=48) -- [Answer](x-devonthink-item://A491A3F6-FD6D-492F-BCBE-7F7BAE101EDF?page=52) - [ ] 19Q: [Penetrating Chest Trauma](x-devonthink-item://7FCD3940-4BB4-45FE-86A6-E5707E82D5B5?page=72) -- [Answer](x-devonthink-item://3263A68A-96A6-43EC-985B-43260C3509BF?page=27) - [x] 20Q: [Stabbed in the Back](x-devonthink-item://7061D1B4-0AB9-4963-B3B0-23BDD975B2CD?page=28) -- [Answer](x-devonthink-item://3F30C77E-E23E-4200-89FE-48A41618E0C2?page=20)