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
-
- 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
-
- Overall survival rate of 20%
-
- 26% survival rate in penetrating trauma
- 7% survival rate in blunt trauma
- Predictors for poor outcomes
-
- 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.
