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Emergency Department Thoracotomy
Karim Brohi, 6:6, June 2001

"The surgeon who should attempt to suture a wound of the heart would lose the respect of his surgical colleagues" - Theodore Bilroth, 1882


Many surgeons still share the pessimism of Bilroth when discussing emergency thoracotomy. Nevertheless, current studies have shown survival rates approaching 60% in selected groups of patients. Shortly after Bilroth dismissed surgery for cardiac injury, the first report of successful management of traumatic cardiac injury was published by Rehn in 1900.

Emergency Thoracotomy

Operative technique

The first successful 'prehospital' thoracotomy and cardiac repair was carried out by Hill on a kitchen table in Montgomery, Alabama in 1902.

Emergency department thoracotomy is a life-saving procedure in a select group of patients. Exactly who these patients are is a matter of some controversy in the trauma literature. There is a significant amount of published data on the indications for and outcomes of resuscitative thoracotomy. However the results of interventions varies widely, as does each unit's experience, puclished data ranging for 11 patients in 10 years to 950 patients in 23 years.

Most studies give little indication as to what has gone before (apart from physiological data). Prehospital data such as time of injury, paramedic on-scene time and time in the emergency department prior to thoracotomy are rarely given. The use of prehospital manoeuvers that may worsen outcome, such as external chest compressions and large volume fluid resuscitation, are also not routinely published. Similarly, the indications for performing surgery are not uniform and inconsistently applied, or not recorded at all. There are only 3 prospective studies in the literature.

This article discusses the indications for emergency department thoracotomy and describes the operative technique as well as resuscitative management of these patients. Emergency department thoractomy is performed in the emergency room for patients in extremis due to traumatic injury.