Emergency thoracotomy

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

Technique

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.

Recovery

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.