ABSTRACT
Resuscitative thoracotomy (RT) is the performance of left anterolateral thoracotomy, potentially but not necessarily with extension to the right chest (i.e., “clamshell’ thoracotomy), in a patient with cardiovascular collapse after traumatic injury. In the absence of conclusive evidence to guide management, the decision to perform RT continues to rely on the clinical judgment of trauma physicians. Although institutional protocols have been advocated, the heterogeneity of patient and injury factors in such cases continues to demand a risk-benefit analysis on a case-by-case basis. Based on the retrospective data available, RT after blunt trauma is associated with a low overall rate of survival (1–10%). However, these results should be interpreted in the context of nearly universal lethality of cardiac arrest after blunt trauma with standard resuscitation efforts. Small retrospective reports have suggested that the use of RT may facilitate salvage in a select group of agonal patients with exsanguinating vascular injuries in the abdomen and pelvis.
