Resuscitative thoracotomy Why? When? How?

Resuscitative thoracotomy is an emergency thoracotomy carried out on patients who are in a periarrest state or in established cardiac arrest, associated with improved survival in selected patients. 

There are 4 main objectives: cardiac tamponade release; intrathoracic haemorrhage control; aortic cross-clamp and internal cardiac massage. The main outcome is the patient's return of spontaneous circulation, which should be followed either by a definitive surgical repair in the operating room or by intensive care unit admission.

The prognostic factors associated with better outcomes are penetrating trauma, presence of signs of life, no extra-thoracic trauma, isolated cardiac trauma and shorter elapsed time after cardiac arrest.