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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