Resuscitative Thoracotomy

ED ThoracotomyRosie Stroud

(with a few slides from Jeremy’s presentation)

https://www.youtube.com/watch?v=ZT152jD8C4Q

Release of pericardial tamponade — improves cardiac output and control of cardiac haemorrhage

Control of intrathoracic vascular or cardiac haemorrhage — improves cardiac output and myocardial perfusion

Control of massive air embolism or bronchopleural fistula — resolves myocardial ischaemia and hence  improves myocardial contractility as well as prevents neurological injury

Open cardiac massage —improves resuscitative cardiac output and coronary perfusion especially with limited ventricular filling pressures

Occlusion of the descending aorta (cross-clamping) —Redistribution of limited blood volume to myocardium and brain as well as limiting subdiaphragmatic losses.

Relative Contra-indications

Pre-hospital CPR performed for >15 minutes after penetrating chest injury without response

Pre-hospital CPR performed for >10 minutes after blunt chest injury without response

the presence of coexistent injuries that are unsurvivable, e.g. severe head trauma (an exception maybe the patient who is a potential organ donor)

asystole is the presenting rhythm, and there is no pericardial tamponade

(You are in a setting where there is no surgical support)

Signs of Lifepresence of a pulse or spontaneous movementsGCS>3presence of pupillary reflexes, corneal reflexes

or gag reflexesevidence of cardiac electrical activity on ECG, or

contractile activity on bedside ultrasound

Hunt el al 2005

A 26 year old man has been BIBA as a priority following a serious chest injury. The trauma team has been assembled

and the patient is transferred onto the trauma table…

He has been stabbed in the left side of his chest with signs of life at scene

What do you do if he has no signs of life now?What if he is in PEA?What if his blood pressure is less than 60

systolic and non responsive to fluids?What if his blood pressure is 90 systolic and

seems to be improving?