Place de la thoracotomie de ressuscitation

Resuscitation thoracotomy is a rarely performed procedure whose use, in France, remains marginal. It has five specific goals that correspond point-by-point to the causes of traumatic cardiac arrest: decompression of pericardial tamponnade, control of cardiac hemorrhage, performance of internal cardiac massage, cross-clamping of the descending thoracic aorta, and control of lung injuries and other intra-thoracic hemorrhage. This approach is part of an overall Damage control strategy, with a targeted operating time of less than 60 minutes. It is indicated for patients with cardiac arrest after penetrating thoracic trauma if the duration of cardio-pulmonary resuscitation (CPR) is < 15 minutes, or < 10 minutes in case of closed trauma, and for patients with refractory shock with systolic blood pressure < 65 mmHg. The overall survival rate is 12 % with a 12 % incidence of neurological sequelae. Survival in case of penetrating trauma is 10 %, but as high as 20 % in case of stab wounds, and only 6 % in case of closed trauma. As long as the above-mentioned indications are observed, resuscitation thoracotomy is fully justified in the event of an afflux of injured victims of terrorist attacks.