Indications

While the technique of emergency thoracotomy is fairly standard, the indications for performing surgery remain a source of controversy.

The following are a suggested set of guidelines for general use. In practice these will vary with local resources and skill availability.

Emergency Thoracotomy

Introduction
Indications
Rationale
Resuscitation
Operative technique
References
 

Accepted Indications

Penetrating thoracic injury
   - Traumatic arrest with previously witnessed cardiac activity (pre-hospital or in-hospital)
   - Unresponsive hypotension (BP < 70mmHg)

Blunt thoracic injury
   - Unresponsive hypotension (BP < 70mmHg)
   - Rapid exsanguination from chest tube (>1500ml)

Relative Indications

Penetrating thoracic injury
   - Traumatic arrest without previously witnessed cardiac activity

Penetrating non-thoracic injury
   - Traumatic arrest with previously witnessed cardiac activity (pre-hospital or in-hospital)

Blunt thoracic injuries
   - Traumatic arrest with previously witnessed cardiac activity (pre-hospital or in-hospital)

Contraindications

Blunt injuries
   - Blunt thoracic injuries with no witnessed cardiac activity
   - Multiple blunt trauma
   - Severe head injury

Rationale
Karim Brohi, trauma.org 6:6, June 2001