Indication
- Patients presenting with penetrating thoracic injury who arrives pulseless, but with myocardial electrical activity.
Benefits
- Evacuation of pericardial clots
- Direct control of exsanguinating intrathoracic hemorrhage
- Open cardiac massage
- Cross clamping of descending aorta
Procedure
- Clamshell thoracotomy : Clampshell technique is considered as preferred method in ED.
- Anterolateral thoracotomy
Recent Evidence
- Joseph et al (Jamcollsurg.2020) did an observational study from the AORTA registry to compare whether resuscitative thoracotomy done using left anterolateral (AT) or clamshell thoracotomy (CT) was better. Study population was 1218 patients from AORTA registry who underwent RT . Overall survival was 6% (AT 6.6% 59 of 900 v/s CT 4.2% 13 OF 296; P=0.132). Study found that clamshell thoracotomy facilitates thoracic life saving procedures without increased systemic or thoracic complications compared with AT inpatients undergoing RT.
- Perkins et al (JAMA Surg. 2025) did a retrospective cohort study of all cases of prehospital thoracotomy for Traumatic Cardiac Arrest in London from Jan 1999 to Dec 2019. Study analysed 601 patients who underwent prehospital thoracotomy . They found that 30 patients (5%) survived to hospital discharge, with favourable neurological outcome in 23 survivors. Study also found that survival varied with cause of arrest : 22 of 105 patients (21%) with cardiac tamponade , 8 of 418 patients (1.9%) with exsangunation. Study also noted that there was no survivors beyond 15 minutes of TCA due to cardiac tamponade and 5 minutes after exsanguination.
Reference
- https://doi.org/10.1016/j.jamcollsurg.2020.09.002
- https://www.ctsnet.org/article/emergency-anterior-bilateral-thoracotomy
