Oct 24, 2022
Contributor: Jared Scott, MD
Educational Pearls:
- Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest
- Western Trauma Association Society Criteria for ED thoracotomy
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- Blunt trauma + <10 min of prehospital CPR
- Penetrating trauma to torso + <15 min prehospital CPR
- Penetrating trauma to the neck/extremity + <5 min prehospital CPR
- Signs of life with refractory shock can consider resuscitative thoracotomy
- Outcomes in immediate resuscitative thoracotomy are poor but are improving
- A recent study evaluated over 2,000 patients meeting inclusion criteria for immediate resuscitative thoracotomy
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- Overall survival rate of 20%
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- 26% survival rate in penetrating trauma
- 7% survival rate in blunt trauma
- Predictors for poor outcomes
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- Patient age > 60 years
- Blunt trauma mechanism of injury
- A prehospital or ED HR <60 bpm
- Absent signs of life at time of ED arrival
- When criteria are met, immediate resuscitative thoracotomy should rapidly be performed in the ED
References
Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363.
Panossian VS, Nederpelt CJ, El Hechi MW, et al. Emergency Resuscitative Thoracotomy: A Nationwide Analysis of Outcomes and Predictors of Futility. J Surg Res. 2020;255:486-494.
Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD
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