Resuscitative thoracotomy in medical cardiac arrest… time to open the chest?


We all know that the only evidence for resuscitation in cardiac arrest lies in good quality chest compressions. We also know that it is possible to perform internal cardiac massage during surgery or even after resuscitative thoracotomy for penetrating (or dare I say blunt) trauma.

In this interesting article, they suggest that the use of open-chest cardiac compressions has unjustly fallen by the wayside since the popularisation of closed chest cardiac compressions in the 1960s. While most of the data in this article are from animal studies, the questions asked are:

  • Could the better physiological effect and better outcomes demonstrated from internal cardiac massage balance out the risks and complications of a thoracotomy?
  • Is there a place in cardiac arrest algorithms for a thoracotomy?

Outcomes following cardiac arrest have not significantly changed for decades; are we being held back by the chest wall? Have a read, and see what you think. Is this fanciful musing from slash-happy resuscitators, or a potential technique that might improve cardiac arrest outcomes?


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