Background

ERT, also called “emergency department thoracotomy,” is an extreme procedure, performed in the small subset of patients who arrive either in full post-injury arrest, who rapidly progress to arrest after arrival, or who have impending arrest that precludes immediate transport to an operating room. Exsanguinated patients with profound hypotension or in hemorrhagic shock do not improve with external chest compressions.1

The physiologic rationale of ERT is based on both

1. treating several potential sources of bleeding (control cardiac or other intrathoracic bleeding and prevent infra-diaphragmatic exsanguination) and
2. restoring an adequate cardiac output (releasing pericardial tamponade, improving cerebral and coronary perfusion, performing open cardiac massage).

Resuscitative thoracotomy has been extensively described in the civilian trauma literature and has a high mortality rate, largely due to the nature of the injuries leading ERT.2-5 The survival rates are highest (10 to 30%) for penetrating truncal injuries and patients who arrive with vital signs. They are significantly lower (less than 5%) for blunt trauma victims, particularly those who arrest in the field or during transport (1% or less). In addition, the likelihood of survival with intact neurologic function is significantly lower than the overall survival rates, particularly for blunt trauma victims and for pre-hospital arrest.

In a combat or operational environment, several specific factors must be considered as studies of wartime ERT are available and indicate that there is a reasonable probability of long-term survival and recovery following ERT in appropriately selected casualties.6-10