Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Vledder, Mark G. van; Waes, Oscar J.F. Van; Kooij, Fabian O.; Peters, Joost; Lieshout, Esther M.M. Van; Verhofstad, Michael H.J.

doi:10.1016/j.injury.2017.04.002

Cited by 31 publications

(16 citation statements)

References 14 publications

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“…There has been growing international interest in taking invasive interventions used in the in-hospital setting to the prehospital setting, such as thoracotomy and resuscitative endovascular balloon occlusion of the aorta (REBOA). Previous studies are limited to very small numbers [42][43][44], and our results reflect this with panels suggesting that only two cases may have benefited from REBOA and no cases may have benefited from prehospital thoracotomy. Thus, the establishment of a system to provide REBOA or thoracotomies in our prehospital setting cannot be justified based on improvements in mortality.…”

Section: Discussionsupporting

confidence: 86%

Potentially preventable trauma deaths: A retrospective review

Beck

Smith

Mercier

et al. 2019

Injury

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Section: Discussionsupporting

confidence: 86%

Potentially preventable trauma deaths: A retrospective review

Beck

Smith

Mercier

et al. 2019

Injury

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“…The primary goal is to treat a possible cardiac tamponade and/or stop intrathoracic bleeding, thereby resolving the cause for cardiac arrest. 3 In addition, it offers access to open cardiac massage and the possibility to clamp the thoracic aorta to attenuate distal bleeding.…”

Section: Discussionmentioning

confidence: 99%

“…The details of the technique applied have been described in previous publications. 3,5 A cadaver study in 2013 5 enforced the beliefs that the clamshell technique for emergency thoracotomy is the preferred technique. The procedure can be summarized in the following steps as applied in our case:…”

Section: Discussionmentioning

confidence: 99%

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Clamshell in a Heartbeat

Vreeswijk

Mommers

Bergmans

et al. 2020

Air Medical Journal

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There is a restrained attitude toward the implementation and performance of resuscitative thoracotomy as a last resort procedure in patients with cardiac arrest after penetrating thoracic trauma. We present a case with a remarkable recovery and hope to boost morality in the use of this procedure in the prehospital setting. A disoriented 25-year-old woman stabbed multiple times was found next to the highway. Her clinical situation deteriorated swiftly upon arrival of the helicopter emergency medical services. They were able to perform a clamshell thoracotomy and fly the patient out to the nearest trauma center. She awoke with good neurologic function. Her hospital admission was complicated by mediastinitis. A routine cardiac ultrasound showed mitral valve insufficiency due to combined perforation of the anterior leaflet and ventricular septum. Both lesions were in the trajectory of the primary stab wound. Successful outcome in our case was due to the following: little delay between clinical deterioration and the arrival of the helicopter emergency medical services physician (signs of life on arrival of paramedics are an independent predictor of survival), young age and penetrating injury are associated with a good neurologic outcome in case of traumatic cardiac arrest, and extensive follow-up cardiac ultrasound as part of tertiary survey after resuscitative emergency thoracotomy is advised.

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“…However, it was in other countries, such as Great Britain, Japan, Australia, Holland, Austria, and Spain, where PET became recognized as part of the algorithm used for severe trauma patients. [2,4,[9][10][11] In recent years, there has been an increase in the number of case reports and case series of patients for whom PET was performed, with both penetrating and blunt injuries. [1,2,[11][12][13][14][15] The presented case is probably the first example of an effective prehospital emergency thoracotomy performed on-scene in Poland.…”

Section: Discussionmentioning

confidence: 99%

Prehospital Emergency Thoracotomy Performed by Helicopter Emergency Medical Service Team—A Case Report.

Darocha

Kosiński²,

Serednicki

et al. 2018

Ulus Travma Acil Cerrahi Derg

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Emergency thoracotomy can be a life-saving procedure in critically injured patients who present with chest injuries. Currently, the indications for an on-the-scene thoracotomy are penetrating trauma of the chest or upper abdomen with cardiac arrest that has occurred in the presence of an emergency team or within 10 minutes prior to their arrival. The indications for an emergency thoracotomy in blunt chest trauma are less clearly defined. In the present case, a helicopter emergency medical service (HEMS) team performed an emergency thoracotomy at the scene. To the best of our knowledge, it is the first description of such a procedure in Poland. A 41-yearold male was crushed in a tractor accident. Though all available measures were taken, a sudden cardiac arrest occurred. The HEMS team performed an emergency thoracotomy at the scene as an integral part of prehospital cardiopulmonary arrest management. The patient survived, and was later discharged from the hospital in good physical condition. No neurological deficit was identified (cerebral performance category 1). The patient returned to his previous activities with no complications or deficits. The presence of a fully trained crew allows for the performance of a potentially critical on-the-scene emergency thoracotomy. In a well-selected group of patients with blunt thoracic injury, a prehospital emergency thoracotomy may be a significant and life-saving procedure.

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Out of hospital thoracotomy for cardiac arrest after penetrating thoracic trauma

Abstract: Introduction: Emergency department thoracotomy is an established procedure for cardiac

Cited by 31 publications

References 14 publications

Potentially preventable trauma deaths: A retrospective review

Potentially preventable trauma deaths: A retrospective review

Clamshell in a Heartbeat

Prehospital Emergency Thoracotomy Performed by Helicopter Emergency Medical Service Team—A Case Report.

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