Podcast 823: Immediate Resuscitative Thoracotomy - The Emergency Medical Minute

Podcast 823: Immediate Resuscitative Thoracotomy

Contributor: Jared Scott, MD

Educational Pearls:

  • Immediate resuscitative thoracotomy can be performed in the ED to gain rapid access to the thoracic cavity in cases of traumatic cardiac arrest
  • Western Trauma Association Society Criteria for ED thoracotomy
    • Blunt trauma + <10 min of prehospital CPR
    • Penetrating trauma to torso + <15 min prehospital CPR
    • Penetrating trauma to the neck/extremity + <5 min prehospital CPR
    • Signs of life with refractory shock can consider resuscitative thoracotomy
  • Outcomes in immediate resuscitative thoracotomy are poor but are improving
  • A recent study evaluated over 2,000 patients meeting inclusion criteria for immediate resuscitative thoracotomy
    •  Overall survival rate of 20%
      • 26% survival rate in penetrating trauma
      •  7% survival rate in blunt trauma
    • Predictors for poor outcomes
      • Patient age > 60 years
      • Blunt trauma mechanism of injury
      • A prehospital or ED HR <60 bpm
      • Absent signs of life at time of ED arrival
  • When criteria are met, immediate resuscitative thoracotomy should rapidly be performed in the ED


Burlew CC, Moore EE, Moore FA, et al. Western Trauma Association critical decisions in trauma: resuscitative thoracotomy. J Trauma Acute Care Surg. 2012;73(6):1359-1363.

Panossian VS, Nederpelt CJ, El Hechi MW, et al. Emergency Resuscitative Thoracotomy: A Nationwide Analysis of Outcomes and Predictors of Futility. J Surg Res. 2020;255:486-494.


Summarized by Mark O’Brien, MS4 | Edited by John Spartz, MS4 & Erik Verzemnieks, MD

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