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Case Reports
. 2025 Jul 17;2025(7):rjaf527.
doi: 10.1093/jscr/rjaf527. eCollection 2025 Jul.

A series of successful emergency department thoracotomies with expeditious recovery

Jessica A Nicholson  1 , Mahmoud K Abd-El-Hafez  1 , Andrew G Nicholson  1 , Tanya J T Starr  1 , Celeste M Murtha  2 , Mark J Lieser  3 , John M Chipko  3
Affiliations
Case Reports

A series of successful emergency department thoracotomies with expeditious recovery

Jessica A Nicholson et al. J Surg Case Rep. .

Abstract

Resuscitative thoracotomy is an invasive, morbid procedure indicated in the emergent management of blunt or penetrating trauma to the chest. It allows for rapid access to the thoracic cavity and treatment of the underlying pathology. Survival following traumatic cardiac injury relies on a near-impeccable combination of rapid assessment by properly trained emergency medical services personnel, rapid transport to a capable emergency center, accelerated access to the thoracic cavity within 10 min of cardiopulmonary resuscitation initiation, and excellent perioperative resuscitation. Overall survival rate following resuscitative thoracotomy in the United States is 9.6%. In addition, not all who survive make an acceptable neurocognitive recovery, with one large meta-analysis quoting only 92.4%. We report on two patients who survived and made a complete neurocognitive recovery following emergency department thoracotomy secondary to penetrating cardiac trauma. Both patients were discharged from the hospital within 16 days of their emergency department thoracotomy.

Keywords: ED thoracotomy; cardiac massage; cardiopulmonary resuscitation; clamshell thoracotomy; resuscitative thoracotomy; thoracotomy.

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Conflict of interest statement

None declared.

Figures

Figure 1
Figure 1
Clamshell thoracotomy in the ED for bilateral access to the thoracic cavity and mediastinum.
See this image and copyright information in PMC

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