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Resuscitative thoracotomy: What you need to know
Morgan G Dewey1, Ernest E Moore, Angela Sauaia
1From the University of Colorado School of Medicine (M.G.D., E.E.M.), Aurora; Ernest E Moore Shock Trauma Center (E.E.M.), Denver, Colorado; Sauaia Statistical Solutions LLC (A.S.), Denver, Colorado; and AdventHealth Medical Group (H.B.M.) Denver Colorado.
The Journal of Trauma and Acute Care Surgery
|December 19, 2025
Summary
Resuscitative thoracotomy (RT) is a critical procedure for traumatic cardiac arrest, addressing tamponade and bleeding. Advances refine its use, improving outcomes in select patients, especially with penetrating trauma.
Area of Science:
- Emergency Medicine
- Trauma Surgery
- Cardiovascular Surgery
Background:
- Resuscitative thoracotomy (RT) is a life-saving intervention for traumatic cardiac arrest.
- It addresses critical issues like cardiac tamponade and intrathoracic hemorrhage.
- Recent trauma care advancements have refined RT indications and improved patient outcomes.
Purpose of the Study:
- To review current techniques, indications, and outcomes of RT.
- To explore future directions in RT, including REBOA and ECMO.
- To guide trauma providers in optimizing RT patient selection and procedural techniques.
Main Methods:
- This is a review article, synthesizing existing literature on resuscitative thoracotomy.
- It focuses on physiologic objectives, indications, and survival data.
- The review examines comparative outcomes between penetrating and blunt trauma patients.
Main Results:
- RT is indicated for profound hypotension or traumatic cardiac arrest with <15 minutes of CPR.
- Survival rates for RT are significantly higher in penetrating trauma (>15%) versus blunt trauma (<2%).
- Key physiologic goals include releasing tamponade, controlling hemorrhage, and facilitating resuscitation.
Conclusions:
- RT remains a vital procedure in specific traumatic cardiac arrest scenarios.
- Future research should focus on refining indications with new technologies like REBOA and ECMO.
- Optimizing patient selection and procedural technique is crucial for improving RT outcomes.
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