Resuscitative Thoracotomy

Annotation for Point F

Those patients diagnosed with cardiac injury after pericardotomy should undergo cardiac repair, in the trauma bay or the operating room.33,34 Cardiac bleeding sites should be controlled immediately with digital pressure on the surface of the ventricle and partially occluding vascular clamps on the atrium or great vessels. Efforts at definitive, hemostatic, cardiorrhaphy may be delayed until initial resuscitative measures have been completed. In the nonbeating heart, cardiac repair is performed before defibrillation and cardiac massage. Cardiac wounds in the thick walled left ventricle are best repaired with 3-0 nonabsorbable running or horizontal mattress sutures. Buttressing the suture repair with polytetrafluoroethylene (Teflon) pledgets is preferred for the thinner right ventricle. When suturing a ventricular laceration, care must be taken not to incorporate a coronary vessel into the repair. In these instances, vertical mattress sutures should be used to exclude the coronary and prevent cardiac ischemia. In the more muscular left ventricle, particularly with a linear stab wound, control of bleeding can often be temporized with a skin-stapling device. Low-pressure venous and atrial lacerations can be repaired with simple running or purse-string sutures. Use of a Foley catheter for temporary occlusion of cardiac injuries has been suggested, but this may inadvertently extend the injury owing to traction forces. RT has the highest survival rate following isolated cardiac injury:6,18,35 35% of adult patients presenting in shock and 20% without vital signs were salvaged after isolated penetrating injury to the heart if RT was performed.5