Since its introduction in 1900, the emergency department thoracotomy (EDT, sometimes referred to as emergency resuscitative thoracotomy) has been a subject of intense debate. It is a drastic, last-ditch effort to save the life of a patient in extremis due to injury.
Although some studies boast a 60% survival rate, others have argued that EDT is a futile and expensive procedure that only places health care providers at significant personal risk. Further, indications for EDT have widely varied. For these reasons, the EDT remains a controversial but potentially lifesaving procedure in a select group of patients.
The causes of acute circulatory arrest after chest injury include hemorrhagic shock due to injury to the heart or intrathoracic vasculature, cardiac tamponade, and tension pneumothorax.
The primary goals of EDT include the following
Release of cardiac tamponade
Facilitation of internal/open cardiac massage
Prevention of air embolism
Exposure of the descending thoracic aorta for cross-clamping
Repair cardiac or pulmonary injury
Emergent thoracotomy typically takes place in the emergency department or operating room. It is crucial for the emergency provider to consult a surgeon upon the patient’s arrival to facilitate with the procedure if possible or to manage the patient subsequent to the thoracotomy. Emergent thoracotomies have been successfully performed in the prehospital setting by physicians and emergency medical service teams.
Rapid transport to the emergency department is associated with higher survival rates in thoracic injury.