Emergency Thoracotomy for Trauma

Introduction

Resuscitative emergency thoracotomy can be a lifesaving procedure for patients in traumatic cardiac arrest. As a salvage maneuver, the associated mortality is high, and the search to clarify indications has sparked controversy since its first description. Patients who are pulseless with signs of life after penetrating thoracic trauma have the highest chance of survival after emergency thoracotomy ( Fig. 51.1A ). Additional indications include penetrating extrathoracic trauma and patients with signs of life after blunt injury. Knowledge of indications and anatomy is crucial to good patient outcomes.

Surgical Principles

Five main maneuvers can be performed, depending on the findings:

• 1.

  Thoracotomy

• 2.

  Open pericardium

• 3.

  Cardiac massage

• 4.

  Damage control

• 5.

  Aortic cross-clamp