Emergency Medical Minute24 Okt 2022

Podcast 823: Immediate Resuscitative Thoracotomy

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.

Summarized by Mark O'Brien, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD

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