Episode 14: Thoracotomy

thoracotomy

 

Details of the surgical skills course mentioned in the podcast can be found here:

https://wmstc.co.uk/portfolio/phem-ess/

The Sydney HEMS Traumatic Cardiac arrest operating procedure can be viewed on their website, and there are a number of useful references within the document:

Policies and Procedures

An excellent ‘how to do it’ paper, published in 2005, by the London HEMS team, can be accessed via the link below:

https://www.ncbi.nlm.nih.gov/pmc/articles/PMC1726527/pdf/v022p00022.pdf

 

Equipment required for resuscitative thoracotomy:equipment-required-for-thoracotomy

Surface anatomy:

surface-anatomy-for-thoracotomy

Appearance of pericardial clot

pericardial-clot

A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out.

foley-catheter-in-cardiac-wound

An open chest with aortic compression

open-chest-with-aortic-compression

Simulation of resuscitative thoracotomy by London HEMS team.

For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Highly recommended.

http://intensivecarenetwork.com/hinds-crack-the-chest-get-crucified/

And for a summary of the evidence and recommendations, have a look at the St Emlyns blog:

http://stemlynsblog.org/jc-east-lets-be-blunt-about-ed-thoracotomy/

References

  • Smith JE, Rikard A, Wise D. Traumatic Cardiac Arrest. Journal of the Royal Society of Medicine 2015. 108(1): 11-16.
  • Wise et al. Emergency thoracotomy: “how to do it”. EMJ; 2005: 22-24.
  • Hunt et al. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19.
  • Clay et al. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World Journal of Emergency Surgery; 2006: 1:4.
  • Rhee et al. Survival after Emergency Department thoracotomy: review of published data for last 25 years. J Am Coll Surg; 2000. 190(3): 288-298
  • ACS Committee on Trauma Working Group. Practice Management guidelines for ED Thoracotomy. J Am Coll Surg. 2001, 193 (3): 303-309.
  • Editorial. When should we stop resuscitative efforts after blunt traumatic arrest. Injury; 2008 (39): 967-969.
  • Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital cardiopulmonary arrest. J Am Coll Surg; 2003 (1): 106-111.
  • Tarney et al.Outcomes following military traumatic cardiorespiratory arrest: A prospective observational study. Resuscitation; 2011: 1194-1197

4 thoughts on “Episode 14: Thoracotomy

  1. Pingback: Episode 14: Thoracotomy — phemcast | Prehospital and Retrieval Medicine - THE PHARM dedicated to the memory of Dr John Hinds

  2. I’d argue that intubation isn’t a priority in these patients. Oxygenation is. When trying to get things done quickly with limited resources probably best to stick an iGel in with EtCO2. Can worry about intubation once some semblance of control occurs. Nothing should get in the way of “getting in the chest”

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