Anterolateral thoracotomy (resuscitative thoracotomy)
Anterolateral thoracotomy is the standard emergency thoracic incision used in resuscitative thoracotomy (RT) to provide rapid access to the heart, pulmonary hilum and intrathoracic great vessels.
In the emergency department it is a time‑critical, potentially life‑saving intervention for carefully selected patients with traumatic cardiac arrest (TCA) or near‑arrest from intrathoracic catastrophe (cardiac tamponade, massive intrathoracic haemorrhage, major airway/vascular injury).
RT is a major invasive ED procedure and must be performed only within an agreed local governance framework by clinicians trained in the technique, with equipment, blood and a clear pathway to definitive surgical or cardiothoracic care (RCEM; Resuscitation Council UK).
Key points
- Best candidates: witnessed penetrating thoracic trauma with very short downtime and signs of life; survival is concentrated in this group (RCEM).
- Time critical: very short arrest interval (commonly cited favourable window <10 minutes) and any signs of life strongly favour attempting RT; prolonged unwitnessed arrest with no signs of life usually predicts futility (RCEM).
- RT is part of a TCA algorithm - priorities remain haemorrhage control, prompt decompression for suspected tension pneumothorax (open thoracostomy), rapid transfusion and POCUS for tamponade (Resuscitation Council UK; RCEM).
- Governance and safety: require senior confirmation, team briefing, equipment checklist, two‑person verification, immediate documentation and a hot debrief (RCEM invasive‑procedures guidance).
- Procedural detail in this chapter is surgical technique and...
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