Resuscitative Thoracotomy

Historical Perspective

Emergent thoracotomy came into use in the United States in the late 1800s and early 1900s for the treatment of injuries to the heart as well as for cardiac arrest. In 1874, Schiff promoted the concept of thoracotomy for open cardiac massage.¹² At the turn of the century, thoracotomy as a resuscitative measure had expanded indications for the treatment of penetrating chest injuries.^13,14 Although the most common reason for thoracotomy in the early 1900s was cardiovascular collapse from medical causes, the demonstrated efficacy of closed-chest compression in 1960¹⁵ and the introduction of external defibrillation in 1965¹⁶ virtually eliminated the practice of open-chest resuscitation for medical causes. The use of emergent thoracotomy following trauma initially declined in the 1940s as less invasive therapeutics, such as pericardiocentesis for cardiac tamponade, were preferred.¹⁷ However, in the late 1960s, the pendulum swung again toward emergent thoracotomy, promulgated by the Ben Taub group for resuscitation of the moribund patient with penetrating cardiovascular injuries.¹⁸ In the 1970s, the Denver General Hospital³ and the San Francisco General Hospital¹⁹ challenged the appropriate role and clinical indications for RT. In the ensuing swing of the pendulum during the subsequent four decades, several groups have attempted to elucidate the clinical guidelines for RT.^{2,3,6-11,20-32}