Abstract
There is a restrained attitude toward the implementation and performance of resuscitative thoracotomy as a last resort procedure in patients with cardiac arrest after penetrating thoracic trauma. We present a case with a remarkable recovery and hope to boost morality in the use of this procedure in the prehospital setting. A disoriented 25-year-old woman stabbed multiple times was found next to the highway. Her clinical situation deteriorated swiftly upon arrival of the helicopter emergency medical services. They were able to perform a clamshell thoracotomy and fly the patient out to the nearest trauma center. She awoke with good neurologic function. Her hospital admission was complicated by mediastinitis. A routine cardiac ultrasound showed mitral valve insufficiency due to combined perforation of the anterior leaflet and ventricular septum. Both lesions were in the trajectory of the primary stab wound. Successful outcome in our case was due to the following: little delay between clinical deterioration and the arrival of the helicopter emergency medical services physician (signs of life on arrival of paramedics are an independent predictor of survival), young age and penetrating injury are associated with a good neurologic outcome in case of traumatic cardiac arrest, and extensive follow-up cardiac ultrasound as part of tertiary survey after resuscitative emergency thoracotomy is advised.
Highlights
Resuscitative thoracotomy is a resuscitative procedure in patients with cardiac arrest after penetrating thoracic trauma
We present a case of resuscitative thoracotomy after penetrating thoracic trauma with a remarkable recovery and hope to boost morality in its use in the prehospital setting
Both lesions were in the trajectory of the primary stab wound. Because she had stable hemodynamics, surgery was not yet indicated, and the lesions were followed up by a cardiologist. This case illustrates that resuscitative thoracotomy on scene can result in a favorable outcome despite the remote area, the cold conditions, and the poor surgical conditions
Summary
Resuscitative thoracotomy is a resuscitative (bailout) procedure in patients with cardiac arrest after penetrating thoracic trauma. Rhee et al[1] showed survival rates with a good neurologic outcome in 20% of emergency department patients with a single stab wound in the chest. This results in a restrained attitude toward the implementation and performance of the clamshell procedure.[3] We present a case of resuscitative thoracotomy after penetrating thoracic trauma with a remarkable recovery and hope to boost morality in its use in the prehospital setting.
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