A UK Prehospital Emergency Medicine Podcast. This podcast and associated website aims to: - Share knowledge and expertise in the field of prehospital medicine with specific reference to the UK working environment - Make this content relevant to all professional prehospital practitioners
https://phemcast.co.uk
Episode 14: Thoracotomy
https://phemcast.files.wordpress.com/2016/12/final-thora.mp3
Details of the surgical skills course mentioned in the podcast can be found here:
https://wmstc.co.uk/portfolio/phem-ess/
The Sydney HEMS Traumatic Cardiac arrest operating procedure can be viewed on their website, and there are a number of useful references within the document:
Policies and Procedures
An excellent ‘how to do it’ paper, published in 2005, by the London HEMS team, can be accessed via the link below:
Click to access v022p00022.pdf
Equipment required for resuscitative thoracotomy:
Surface anatomy:
Appearance of pericardial clot
A foley catheter being used to fill a cardiac wound – note how easily this could be pulled out.
An open chest with aortic compression
Simulation of resuscitative thoracotomy by London HEMS team.
For an entertaining and insightful discussion about the impact of undertaking thoracotomy, listen to Dr John Hinds talk from SMACC 2015. Highly recommended.
http://intensivecarenetwork.com/hinds-crack-the-chest-get-crucified/
And for a summary of the evidence and recommendations, have a look at the St Emlyns blog:
http://stemlynsblog.org/jc-east-lets-be-blunt-about-ed-thoracotomy/
References
- Smith JE, Rikard A, Wise D. Traumatic Cardiac Arrest. Journal of the Royal Society of Medicine 2015. 108(1): 11-16.
- Wise et al. Emergency thoracotomy: “how to do it”. EMJ; 2005: 22-24.
- Hunt et al. Emergency thoracotomy in thoracic trauma: a review. Injury; 2006 (37): 1-19.
- Clay et al. Emergency Department thoracotomy for the critically injured patient: Objectives, indications, and outcomes. World Journal of Emergency Surgery; 2006: 1:4.
- Rhee et al. Survival after Emergency Department thoracotomy: review of published data for last 25 years. J Am Coll Surg; 2000. 190(3): 288-298
- ACS Committee on Trauma Working Group. Practice Management guidelines for ED Thoracotomy. J Am Coll Surg. 2001, 193 (3): 303-309.
- Editorial. When should we stop resuscitative efforts after blunt traumatic arrest. Injury; 2008 (39): 967-969.
- Joint Position Statement of Nat Assoc EMS Physicians and ACS Committee on Trauma. Guidelines for withholding or termination of resuscitation in prehospital cardiopulmonary arrest. J Am Coll Surg; 2003 (1): 106-111.
- Tarney et al.Outcomes following military traumatic cardiorespiratory arrest: A prospective observational study. Resuscitation; 2011: 1194-1197