Contributor; Taylor Lynch, MD

Educational Pearls:

Thoracotomy is used in traumatic cardiac arrest to replace conventional CPR with direct access to the chest.
Goals include identifying and controlling reversible causes of bleeding, prioritizing blood flow to the heart and brain, and performing open cardiac massage.

Has a higher chance of survival because the injury may be localized and directly repairable.
Cardiac stab wounds may have the highest survivability because the defect can be visualized, repaired, and treated with blood administration.

Thoracotomy should only be performed when the patient has a reasonable chance of survival.
It is a highly morbid procedure with significant occupational risks, including needlestick injury.
Appropriate patient selection and timing are essential.

Begin on the left side of the chest.
Cross-clamp the aorta to restrict blood flow below the heart and prioritize circulation to the heart and brain.
Identify and repair visible sources of bleeding involving structures such as the heart or lungs.
Perform open cardiac massage as the equivalent of CPR.
ACLS medications may still be administered.

References:

Cothren CC, Moore EE. Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World J Emerg Surg. 2006;1:4. Published 2006 Mar 24. doi:10.1186/1749-7922-1-4
Rhee, Peter M. ; Acosta, Jose ; Bridgeman, Amy et al. / Survival after emergency department thoracotomy : Review of published data from the past 25 years. In: Journal of the American College of Surgeons. 2000 ; Vol. 190, No. 3. pp. 288-298.
Nunn, Andrew ; Prakash, Priya ; Inaba, Kenji et al. / Occupational exposure during emergency department thoracotomy : A prospective, multi-institution study. In: Journal of Trauma and Acute Care Surgery. 2018 ; Vol. 85, No. 1. pp. 78-84.
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. doi:10.1097/TA.0b013e318270d2df
Seamon MJ, Haut ER, Van Arendonk K, et al. An evidence-based approach to patient selection for emergency department thoracotomy: A practice management guideline from the Eastern Association for the Surgery of Trauma. J Trauma Acute Care Surg. 2015;79(1):159-173. doi:10.1097/TA.0000000000000648

Summarized by Steven Fujaros NREMT | Edited by Steven Fujaros & Ahmed Abdel-Hafiz, NREMT-P