Resuscitative thoracotomy performed in the Emergency Department is often utilised as a final salvage manoeuvre, however the procedure does yield survivors. In one of the largest series to date a survival rate of 7.4% occurred with normal neurologic function in 92.4% of survivors whilst London HEMS boasts a 17.8% long-term survival rate for their pre-hospital thoracotomies. There is however no universally accepted criteria for who should and should not undergo this emergent procedure.
Inaba et al have performed a prospective observational trial to examine the ability of the bedside FAST examination to discriminate between survivors and non-survivors after resuscitative thoracotomy.
TAKE HOME MESSAGE
Resuscitative thoracotomy is a high-risk, low-yield procedure. The decision to undertake this intervention should be made in the clinical context of blunt versus penetrating mechanism, absence or presence of vital signs, time from cardiac arrest and the ability of your facility to manage the ongoing care of the patient should your intervention be successful. The likelihood of survival if pericardial fluid and cardiac motion are both absent is zero therefore it is helpful to utilise focussed cardiac ultrasound in this decision making algorithm.
WHAT DO OTHERS HAVE TO SAY ABOUT THIS PAPER?
Inaba K, Chouliaras K, Zakaluzny S, Swadron S, Mailhot T, Seif D, et al. FAST Ultrasound Examination as a Predictor of Outcomes After Resuscitative Thoracotomy: A Prospective Evaluation. Ann Surg. 2015 Aug 31;262(3):512–8.