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Updated: Jan 28, 2026

A Modified Sonographic Algorithm for Image Acquisition in Life-Threatening Emergencies in the Critically Ill Newborn
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Life-saving emergency clamshell thoracotomy with damage-control laparotomy.

Asif Masroor Farooqui1, Clare Cunningham1, Nick Morse2

  • 1Department of Cardiothoracic Surgery, Royal Victoria Hospital, Belfast, UK.

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|March 7, 2019
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Summary

Emergency clamshell thoracotomy saved a young man with penetrating chest trauma and cardiac tamponade. This rare procedure, despite low survival rates, proved life-saving in this critical case.

Keywords:
cardiothoracic surgerytrauma

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Area of Science:

  • Emergency Medicine
  • Trauma Surgery
  • Cardiothoracic Surgery

Background:

  • Clamshell thoracotomy is a rare emergency procedure for severe thoracic injuries.
  • Survival rates for emergency thoracotomy are notably low, especially for blunt trauma (1-2%) and penetrating trauma (9-12%).

Observation:

  • A 23-year-old male presented with penetrating thoracic trauma and cardiac tamponade after multiple stab wounds.
  • The patient was initially awake but deteriorated rapidly, arresting during chest drain insertion.
  • Emergency clamshell thoracotomy was performed, restoring sinus rhythm before surgical repair.

Findings:

  • The patient survived the emergency clamshell thoracotomy and subsequent surgical interventions, including splenic injury repair.
  • Successful resuscitation and recovery were achieved despite the critical nature of the injury and procedure.

Implications:

  • This case highlights the potential life-saving role of emergency clamshell thoracotomy in select cases of penetrating thoracic trauma with cardiac tamponade.
  • It underscores the importance of considering and performing this procedure when conventional methods fail in dire circumstances.
  • The successful outcome suggests that rapid intervention with clamshell thoracotomy can improve survival in otherwise unsurvivable trauma scenarios.