Resuscitative thoracotomy (RT)
Resuscitative thoracotomy (RT), also called emergency thoracotomy, is a time‑critical surgical intervention performed during the initial resuscitation of selected patients with life‑threatening thoracic injury.
Its aims are to treat potentially reversible intrathoracic causes of traumatic cardiac arrest (TCA) - most importantly cardiac tamponade, penetrating cardiac injury and massive intrathoracic haemorrhage - and to permit internal cardiac massage, direct cardiac repair and temporary aortic occlusion.
RT may be undertaken in the prehospital setting, emergency department (ED) or operating theatre depending on local capability and the patient’s condition. National guidance frames RT as a component of the TCA pathway for carefully selected patients, not a routine measure for all traumatic arrests (Resuscitation Council UK; RCEM).
Indications, contraindications and selection principles
Key indications
- Penetrating chest trauma with cardiac arrest and recent signs of life (for example: witnessed collapse, recent organised rhythm, pupillary reactivity).
- Selected blunt trauma with very recent signs of life; benefit is much less likely than for penetrating injury and RT in blunt trauma should generally be confined to major trauma centres with immediate surgical capability (RCEM).
- Ongoing massive intrathoracic haemorrhage despite tube thoracostomy (for example: exsanguination from a chest drain or large ongoing blood loss).
- Cardiac tamponade from penetrating or blunt injury when urgent pericardial decompression is required.
- Selected extra‑thoracic exsanguination where temporary aortic occlusion (manual or...
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