Resuscitative Thoracotomy

Annotation for Point I

The rationale for temporary thoracic aortic occlusion for the patient with massive hemorrhage is multifactorial. First, for patients with hemorrhagic shock, aortic cross-clamping redistributes the patient’s limited blood volume to the myocardium and brain.21,41-44 Second, patients sustaining intra-abdominal injury benefit from aortic cross-clamping owing to a reduction in subdiaphragmatic blood loss.20 Third, occlusion of the descending thoracic aorta increases coronary filling and, thus, seems to increase the return of spontaneous circulation following CPR.43,44 Reports of successful resuscitation using RT for patients in hemorrhagic shock and even sustaining cardiac arrest following extremity and cervical injuries exist.11 In these situations, aortic cross-clamping may effectively redistribute the patient’s blood volume until replacement and control of the hemorrhagic source is possible. Optimally, complete removal of the aortic cross-clamp or replacement of the clamp below the renal vessel should be performed within 30 minutes because of the limited tolerance of the gut to warm ischemia. Furthermore, there is a finite risk of paraplegia associated with the procedure.47-49