Thoracotomy is an incision into the pleural space of the chest. The procedure allows immediate direct access to the thoracic cavity, permitting rescuers to control hemorrhage, relieve cardiac tamponade, repair or control major injuries to the heart, lungs or thoracic vasculature, and perform direct cardiac massage or defibrillation
A left anterolateral thoracotomy is the common method of opening the chest, as it provides rapid access, can be easily extended into the right hemithorax, and provides access to most of the important anatomical structures during resuscitation including the aorta.
First an incision is made along the fourth or fifth intercostal space (between the ribs), intercostal muscles and the parietal pleura are divided, and then the ribs are retracted to provide visualization. When the incision covers both the right and left hemithoraxes it is referred to as a “clamshell” thoracotomy. The clamshell thoracotomy is used when there is a right sided pulmonary or vascular injury, or when greater access or visualization is desired.
Usually those who undergo resuscitative thoracotomy do not recover—only 10% of those receiving it after sustaining a blunt injury and 15–30% of those with penetrating trauma survive.
- November 27, 2012. Resuscitative Thoracotomy. San Diego: The Division of Trauma/Surgical Critical Care/Burns is part of the Department of Surgery, UC San Diego Health System.
- ^ Jump up to:a b Moore 2012, p.462
- ^ Jump up to:a b Biffl, L. Walter (September 2000). “Resuscitative thoracotomy”. Operative Techniques in General Surgery. 2 (3): 168–175. doi:10.1053/otgn.2000.17741.
- ^ Peitzman 2002, p. 227
- ^ Seamon MJ, Chovanes J, Fox N, et al. (September 2012). “The use of emergency department thoracotomy for traumatic cardiopulmonary arrest”. Injury. 43 (9): 1355–61. doi:10.1016/j.injury.2012.04.011. PMID 22560130.
- ^ Jump up to:a b Hunt PA, Greaves I, Owens WA (January 2006). “Emergency thoracotomy in thoracic trauma-a review”. Injury. 37 (1): 1–19. doi:10.1016/j.injury.2005.02.014. PMID 16410079.
- ^ Moore 2012, p. 242
- ^ American College of Surgeons 2008, p. 92
- ^ Moore 2012, p. 240
- ^ Brohi, Karim (6 June 2001). “Emergency Department Thoracotomy”. Trauma.org. Retrieved January 1, 2013.
- ^ Moore 2012, p. 236