Survival after pre-hospital emergency clamshell thoracotomy for blunt cardiac rupture

Blunt trauma causing cardiac rupture is usually fatal. We report a patient with blunt cardiac injury that suffered traumatic cardiac arrest in the pre-hospital phase of their care. A cardiac tamponade was confirmed with portable ultrasound in a brief return of circulation. The patient had a further cardiac arrest and subsequently underwent damage control emergency surgery via a clamshell thoracotomy at the scene. The tamponade was released and a clamp was applied to the identified left atrial appendage rupture, a return of circulation then occurred. He was transferred to a cardiothoracic centre where a left atrial appendage rupture was identified and closed. The patient had a complicated recovery in hospital but went on to survive neurologically intact. This is the first documented case report of a neurologically intact survivor of a pre-hospital clamshell thoracotomy for blunt trauma. Although survivors of blunt trauma who have pre-hospital thoracotomy are extremely rare it should be considered in very specific circumstances.