Resuscitative Thoracotomy

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