Emergency Department Thoracotomy: an Update

Emergency department thoracotomy (EDT) has been considered a heroic, high-risk procedure for patients in extremis since its introduction in 1967, and over the last four decades, the technique has been used with increasing selectivity. Patients with isolated stab wounds to the chest stand the best chance of survival. Most institutions agree that EDT should be performed in patients with penetrating mechanisms of injury who have lost signs of life, but controversy surrounds its use in patients who undergo prehospital CPR or in cases involving blunt mechanisms of traumatic arrest. Dismal outcomes have been reported for patients with penetrating injuries and prehospital CPR >15 min and blunt trauma victims who undergo prehospital CPR. Despite the low survival, the Western Trauma Association advocates EDT in cases of blunt traumatic arrest with CPR <10 min. Biochemical profiles during EDT and outcomes beyond neurologic recovery are currently being investigated, and alternatives such as resuscitative endovascular balloon occlusion of the aorta (REBOA) are emerging.