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FACP. Colegio de médicos de Tarragona Nº 4305520 / fgcapriles@gmail.com




Thursday, October 15, 2020

Resuscitative Thoracotomy

REBEL CRIT - October 15, 2020 - By Zaf Qasim
"Background: A resuscitative thoracotomy is a time-critical high acuity, low occurrence (HALO) procedure – as an emergency physician you need to know how to do it, but depending on your practice environment, it may be a once-in-a-career maneuver. All the more reason that, if you have to do it, you want to make sure your effort counts...
Paper: Newberry R et al. Prospective randomized trial of standard left anterolateral thoracotomy versus modified bilateral clamshell thoracotomy performed by emergency physicians. Annals of Emergency Medicine 2020. PMID: 32807537
Clinical Question: What is the optimal technique for the nonsurgical specialist to perform a resuscitative thoracotomy?
Author Conclusion: “Resuscitative thoracotomy success rates were lower than expected in this capable subject population. Success rates and procedural time for the MCT and LAT were similar. However, the MCT had a higher success rate when performed by staff emergency physicians, resulted in less periprocedural iatrogenic injuries, and was the preferred technique by most subjects. The MCT is a potentially feasible alternative resuscitative thoracotomy technique that requires further investigation.”
Clinical Take Home Point: When faced with a time-critical injury amenable to resuscitative thoracotomy, the emergency physician has precious little opportunity to make a difference in outcome. Therefore, they should adopt the technique that will most likely allow success. This paper shows that for this HALO procedure, the MCT allows timely access to the chest, provides the best exposure to attempt to fix the problem, and decreases the risk of iatrogenic injury. It should be strongly considered by the emergency physician having to perform this while working within the right system to support this procedure."