Emergency Room Thoracotomy: A Multidisciplinary Approach for Emergency, Surgical, and Critical Care Teams
Abstract
Background: Emergency room thoracotomy (ERT) is an aggressive resuscitative procedure performed in extreme, time-critical trauma scenarios. It aims to restore circulation and oxygen delivery by addressing life-threatening intrathoracic injuries such as hemorrhage, cardiac tamponade, and traumatic arrest.
Aim: This study reviews the multidisciplinary approach to ERT, emphasizing indications, contraindications, procedural techniques, and team coordination to optimize outcomes.
Methods: A comprehensive literature-based analysis was conducted, integrating anatomical, physiological, and operational considerations. The review synthesizes evidence on patient selection, procedural steps, equipment requirements, and interprofessional roles, alongside complication profiles and survival data.
Results: ERT demonstrates its greatest benefit in penetrating thoracic injuries with reversible causes of arrest, such as tamponade or exsanguination. Survival rates remain low (7.4–8.5%), but meaningful salvage is possible when strict criteria are met. Contraindications include prolonged pulselessness (>15 minutes), absence of signs of life, and unsurvivable injuries. Key procedural elements include rapid thoracic entry, hemorrhage control, pericardial decompression, and aortic cross-clamping. Success depends on system readiness, simulation-based training, and seamless team coordination.
Conclusion: ERT is a last-resort intervention that can convert imminent death into survival when applied judiciously. Its effectiveness hinges on rigorous patient selection, technical proficiency, and integrated trauma systems.
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Authors
Copyright (c) 2025 Faisal Mesfer Alotaibi, Bader Ahmed Thamer Almsud, Abdullah mohammed Abdullah Alameer, Abdulmajeed Abdu Ahmed Maashi, Talal Ali Alsharari, Mohammed Fihat Alanazi, Tariq Jumauan Dakheel Alsaedi, Zainab Ali Jaffer Al Aseel, Ayman Mohammed Saleh Al-Juaithen, Khalid Mohammed Mohssen Khormi, Mohammed Nasser Mohammed Dhamiri, Talal Mohammed Alanazi, Ali Abdulmohsen Alramadhan
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