TY  - CHAP
M1  - Book, Section
TI  - Resuscitative Thoracotomy
A1  - Burlew, Clay Cothren
A1  - Moore, Ernest E.
A2  - Feliciano, David V.
A2  - Mattox, Kenneth L.
A2  - Moore, Ernest E.
PY  - 2020
T2  - Trauma, 9e
AB  - KEY  POINTSResuscitative  thoracotomy  (RT)  refers  to  an  emergent  thoracotomy,  most  commonly  performed  in  the  emergency  department  for  patients  arriving  in  extremis;  RT  may  also  be  performed  in  the  operating  room  or  intensive  care  unit  within  hours  after  injury  for  physiologic  deterioration.The  primary  objectives  of  RT  are  to  release  pericardial  tamponade,  control  cardiac  or  intrathoracic  hemorrhage,  evacuate  bronchovenous  air  embolism,  perform  open  cardiac  massage,  and  temporarily  occlude  the  descending  thoracic  aorta.The  critical  determinants  of  survival  following  RT  include  the  injury  mechanism,  anatomic  location  of  injury,  and  the  patient’s  physiologic  condition  at  the  time  of  thoracotomy.The  highest  survival  rate  following  RT  is  in  patients  with  penetrating  cardiac  wounds,  especially  when  associated  with  pericardial  tamponade.Based  on  the  literature  to  date,  RT  should  be  performed  for  (1)  penetrating  nontorso  trauma  with  cardiopulmonary  resuscitation  (CPR)  of  less  than  5  minutes,  (2)  blunt  trauma  with  CPR  of  less  than  10  minutes,  and  (3)  penetrating  torso  trauma  with  CPR  of  less  than  15  minutes.RT  is  unlikely  to  yield  productive  survival  when  patients  (1)  sustain  blunt  trauma  and  require  more  than  10  minutes  of  prehospital  CPR,  (2)  have  penetrating  wounds  and  undergo  more  than  15  minutes  of  prehospital  CPR,  (3)  have  isolated  extremity  trauma  with  more  than  5  minutes  of  prehospital  CPR,  or  (4)  manifest  asystole  without  pericardial  tamponade.Outcome  following  RT  in  the  adolescent  population  is  largely  determined  by  injury  mechanism  and  physiologic  status  on  presentation  to  the  emergency  department;  for  patients  under  15  years  of  age,  there  are  only  isolated  cases  of  survival  following  penetrating  trauma  and  no  apparent  survival  benefit  following  blunt  trauma.  
SN  - 
PB  - McGraw Hill
CY  - New York, NY
Y2  - 2024/04/19
UR  - accesssurgery.mhmedical.com/content.aspx?aid=1175131977
ER  -