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Emergency Department Thoracotomy

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The Shock Trauma Manual of Operative Techniques

  • 2015 Accesses

Abstract

Emergency department thoracotomy (EDT) remains an important part of trauma care. There have been a number of guidelines to help the clinician determine the ideal time to perform an EDT. Although they differ slightly, they all suggest that the ideal situation is a single penetrating cardiac injury with signs of life on arrival to the emergency department while those following blunt injury, and no signs of life should not be considered for the procedure. The key components to the procedure include proper placement of the initial incision, pericardiotomy, internal cardiac massage, and aortic cross-clamping. Numerous outcome studies have demonstrated survival rates following EDT are based on mechanism of injury, location of injury, and presence of signs of life. As with any surgical procedures, complications occur and must be managed appropriately.

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References

  1. Hermreck AS. The history of cardiopulmonary resuscitation. Am J Surg. 1988;156:430.

    Article  CAS  PubMed  Google Scholar 

  2. Block: Verhandlungen der Deutschen Gesellschaft für Chirurgie, Elften Congress, Berlin, 1882 part 1 p. 108.

    Google Scholar 

  3. Jeger E. Die Chirurgie der Blutgefässe und des Herzens, 1913;295.

    Google Scholar 

  4. Riedinger F. Verletzungen und Chirurgische Krankheiten des thorax und seines Inhaltes. 1888;42:189.

    Google Scholar 

  5. Rehn L. Ueber Penetrierende Herzwunden und Herznaht. Arch Klin Chir. 1897;55:315–9.

    Google Scholar 

  6. Kouwenhoven WB, Jude JR, Knicekerbocker GG. Closed-chest cardiac massage. JAMA. 1960;173:1064–7.

    Article  CAS  PubMed  Google Scholar 

  7. Beall Jr AC, Ochsner JL, Morris Jr GC, Cooley DA, DeBakey ME. Penetrating wounds of the heart. J Trauma. 1961;1:195–207.

    Article  PubMed  Google Scholar 

  8. Beall Jr AC, Diethrich EB, Crawford HW, Cooley DA, De Bakey ME. Surgical management of penetrating cardiac injuries. Am J Surg. 1966;12:686–92.

    Article  Google Scholar 

  9. Beall Jr AC, Diethrich EB, Cooley DA, DeBakey ME. Surgical management of penetrating cardiovascular trauma. South Med J. 1967;60:698–704.

    Article  PubMed  Google Scholar 

  10. Spoerke NJ, Trunkey DD. Emergency department thoracotomy. In: Cameron JL, Cameron AM, editors. Current surgical therapy. 10th ed. Philadelphia, PA: Elsevier Saunders; 2011.

    Google Scholar 

  11. American College of Surgeons. Thoracic trauma. In: American College of Surgeon – Committee on Trauma, editors. ATLS advanced trauma life support for doctors. 8th ed. Chicago, IL: American College of Surgeons; 2008.

    Google Scholar 

  12. Rhee PM, Acosta J, Bridgeman A, Wang D, Jordan M, Rich N. Survival after emergency department thoracotomy: review of published data from the past 25 years. J Am Coll Surg. 2000;190:288–98.

    Article  CAS  PubMed  Google Scholar 

  13. Working Group, Ad Hoc Subcommittee on Outcomes, American College of Surgeons. Committee on Trauma. Practice management guidelines for emergency department thoracotomy. J Am Coll Surg. 2001;193:303–9.

    Article  Google Scholar 

  14. Powell DW, Moore EE, Cothren CC, Ciesla DJ, Burch JM, Moore JB, et al. Is emergency department resuscitative thoracotomy futile care for the critically injured patient requiring prehospital cardiopulmonary resuscitation? J Am Coll Surg. 2004;199:211–5.

    Article  PubMed  Google Scholar 

  15. Cothren CC, Moore EE. Emergency department thoracotomy. In: Feliciano DV, Mattox KL, Moore EE, editors. Trauma. 6th ed. New York, NY: McGraw-Hill; 2008.

    Google Scholar 

  16. Moore EE, Knudson MM, Burlew CC, Inaba K, Dicker RA, Biffl WL, et al. Defining the limits of resuscitative emergency department thoracotomy: a contemporary Western Trauma Association perspective. J Trauma. 2011;70:334–9.

    Article  PubMed  Google Scholar 

  17. Henry SM, Duncan AO, Scalea TM. Intestinal Allis clamps as temporary vascular control for major retroperitoneal venous injury. J Trauma. 2001;51:170–2.

    Article  CAS  PubMed  Google Scholar 

  18. Oyama M, McNamara JJ, Suehiro GT, Suehiro A, Sue-Ako K. The effects of thoracic aortic cross-clamping and declamping on visceral organ blood flow. Ann Surg. 1983;197:459–63.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  19. Katz NM, Blackstone EH, Kirklin JW, Karp RB. Incremental risk factors for spinal cord injury following operation for acute traumatic aortic transection. J Thorac Cardiovasc Surg. 1981;81:669–74.

    CAS  PubMed  Google Scholar 

  20. Fabian TC, Richardson JD, Croce MA, Smith Jr JS, Rodman Jr G, Kearney PA, et al. Prospective study of blunt aortic injury: multicenter trial of the American Association for the surgery of trauma. J Trauma. 1997;42:374–80.

    Article  CAS  PubMed  Google Scholar 

  21. Kralovich KA, Morris DC, Dereczyk BE, Simonetti V, Williams M, River EP, et al. Hemodynamic effects of aortic occlusion during hemorrhagic shock and cardiac arrest. J Trauma. 1997;42:1023–8.

    Article  CAS  PubMed  Google Scholar 

  22. Perry MO. The hemodynamics of temporary abdominal aortic occlusion. Ann Surg. 1968;168:193–200.

    Article  PubMed Central  CAS  PubMed  Google Scholar 

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Authors and Affiliations

  1. Trauma and Critical Care, R Adams Cowley Shock Trauma Center, Baltimore, MD, USA

    Jay Menaker M.D., F.A.C.E.P

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  1. Jay Menaker M.D., F.A.C.E.P
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Editors and Affiliations

  1. Department of Trauma, R Adams Cowley Shock Trauma Center, Baltimore, Maryland, USA

    Thomas M. Scalea

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© 2015 Springer Science+Business Media New York

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Menaker, J. (2015). Emergency Department Thoracotomy. In: Scalea, T. (eds) The Shock Trauma Manual of Operative Techniques. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-2371-7_3

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  • DOI: https://doi.org/10.1007/978-1-4939-2371-7_3

  • Publisher Name: Springer, New York, NY

  • Print ISBN: 978-1-4939-2370-0

  • Online ISBN: 978-1-4939-2371-7

  • eBook Packages: MedicineMedicine (R0)

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