Emergency Department Thoracotomy in Trauma

Purpose of ReviewResuscitative thoracotomy performed in the Emergency Department is a potentially lifesaving maneuver in select trauma patients. Patient selection is based on guidelines set forth by the Eastern Association for the Surgery of Trauma (EAST) and the Western Trauma Association (WTA), and is predicated on likelihood of survival. This chapter will review technical aspects and trends of the use of resuscitative thoracotomy.Recent FindingsResuscitative thoracotomy is advocated for select patients who suffer from penetrating injuries; rarely blunt trauma victims may also benefit. The procedure consists of entrance to the left chest via a left anterolateral thoracotomy; opening of the pericardium; open cardiac massage; control of pulmonary, cardiac or great vessel injuries; and crossclamping of the descending thoracic aorta. Both direct repair of intrathoracic injuries and aortic crossclamping will provide temporary control of exsanguination, with the goal of transport to the operating room for definitive treatment. Those with penetrating injuries to the thorax, as well as patients in whom cardiopulmonary resuscitation (CPR) has been performed for less than 15 min after penetrating injury, are most likely to benefit from this Emergency Department procedure.While resuscitative thoracotomy has waxed and waned in popularity, patient selection has evolved to maximize survival while minimizing the risks of indiscriminate application. This procedure is an essential resuscitative tool in the armamentarium for all trauma surgeons and emergency medicine physicians.