Emergency thoracotomy in trauma: Rationale, risks, and realities

Kjetil Søreide, P. Petrone, Juan A. Asensio

Research output: Contribution to journalReview article

25 Citations (Scopus)

Abstract

Emergency department thoracotomy (EDT) may serve as a life-saving tool when performed for the right indications, in selected patients, and in the hands of a trained surgeon. Critically injured patients 'in extremis' arrive at an increasing rate in the trauma bay, as an effect of improved pre-hospital trauma systems and rapid transport. Any patient in near, or full cardiovascular shock prompts the trauma surgeon to rapidly perform a thoracotomy. The EDT procedure is managed best by surgeons familiar with, and experienced in, penetrating cardiothoracic injuries. However, the geographical differences in trauma epidemiology lends no, or only scarce, experience with this procedure in most European trauma centres. Consequently, mandatory training is imperative for success. The rationale for performing an EDT is to: (I) resuscitate the agonal patient with penetrating cardiothoracic injuries; (II) release cardiac tamponade by evacuation of pericardial blood; (III) immediately control hemorrhage and repair cardiac or pulmonary injury; (IV) perform open cardiac massage; and (V) place a thoracic aortic cross-clamp to redistribute the remaining blood volume, and perfuse the carotids and coronary arteries. The prevalence rates of blood-borne viruses reported in critically injured patients in the USA (10-20%) exceed the prevalence in the Nordic countries (HIV prevalence 98% die after blunt injury. Based on an updated review of the current available literature, this paper presents the current evidence regarding the rationale, risk, and outcomes for employing EDT in the field of trauma surgery.

Original languageEnglish
Pages (from-to)4-10
Number of pages7
JournalScandinavian Journal of Surgery
Volume96
Issue number1
StatePublished - 2007
Externally publishedYes

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Thoracotomy
Emergencies
Wounds and Injuries
Hospital Emergency Service
Heart Massage
Scandinavian and Nordic Countries
Nonpenetrating Wounds
Cardiac Tamponade
Trauma Centers
Lung Injury
Blood Volume
Carotid Arteries
Shock
Coronary Vessels
Epidemiology
Thorax
HIV
Hemorrhage
Viruses
Surgeons

All Science Journal Classification (ASJC) codes

  • Surgery

Cite this

Emergency thoracotomy in trauma : Rationale, risks, and realities. / Søreide, Kjetil; Petrone, P.; Asensio, Juan A.

In: Scandinavian Journal of Surgery, Vol. 96, No. 1, 2007, p. 4-10.

Research output: Contribution to journalReview article

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