Emergency Department Resuscitative Thoracotomy: Indications, surgical procedure and outcome. A narrative review

Emergency Department Thoracotomy (EDRT) after traumatic Cardio-pulmonary Arrest (CPR) can be used to salvage select critically injured patients. Indications of this surgical procedure are widely debated and changed during last decades. We provide the available literature about EDRT in the effort to provide a comprehensive synthesis about the procedure, likelihood of success and patient’s outcome in the different clinical setting, accepted indications and technical details adopted during the procedure for different trauma injuries. Literature from 1975 to 2020 was retrieved from multiple databases and reviewed. Indications, contraindications, total number and outcome of patients submitted to EDRT were primary endpoints. A total number of 7236 patients received EDRT, but only 7.8% survived. Penetrating trauma and witnessed cardiopulmonary arrest with the presence of vital signs at the trauma center are the most favorable conditions to perform EDRT. EDRT should be reserved for acute resuscitation of selected dying trauma patient. Risks of futility, costs, benefits of the surgical procedure should be carefully evaluated before performing the surgical procedure. •Emergency thoracotomy (ET) is an extreme procedure whose indications are debated.•Anterolateral left thoracotomy and clamshell incision are the most used techniques.•ET in penetrating trauma in patients with witnessed cardiac arrest is associated with a better outcome.•Blunt trauma or prolonged prehospital resuscitation are associated with the worst outcome.•Neurological damage and re-perfusion syndrome are important adverse effects of the ET.