RT Book, Section A1 Burlew, Clay Cothren A1 Moore, Ernest E. A2 Moore, Ernest E. A2 Feliciano, David V. A2 Mattox, Kenneth L. SR Print(0) ID 1147414931 T1 Emergency Department Thoracotomy T2 Trauma, 8e YR 2017 FD 2017 PB McGraw-Hill Education PP New York, NY SN 9780071847292 LK accesssurgery.mhmedical.com/content.aspx?aid=1147414931 RD 2024/03/28 AB The number of patients arriving at hospitals in extremis, rather than expiring in the prehospital setting, has increased due to the maturation of regionalized trauma systems (see Chapter 4). Salvage of individuals with imminent cardiac arrest or those already undergoing cardiopulmonary resuscitation (CPR) often requires immediate thoracotomy as an integral component of their initial resuscitation in the emergency department (ED). The optimal application of emergency department thoracotomy (EDT) requires a thorough understanding of its physiologic objectives, technical maneuvers, and the cardiovascular and metabolic consequences. Although, resuscitative endovascular balloon occlusion of the aorta (REBOA) has been advocated as a resuscitation maneuver that should replace EDT, there is no objective data to substantiate this proposal and we believe its clear role at this moment is for unstable pelvic fractures with advanced hemorrhagic shock (see Chapter 35). This chapter reviews the features of EDT and highlights the specific clinical indications, all of which are essential for the appropriate use of this potentially life-saving yet costly procedure.