Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited

Flaris, Alexandros N.; Simms, Eric R.; Prat, Nicolas; Reynard, Floran; Caillot, Jean-Louis; Voiglio, Eric J.

doi:10.1007/s00268-014-2924-1

Cited by 41 publications

(20 citation statements)

References 37 publications

(52 reference statements)

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“…All survivors ( n = 13) had a cardiac tamponade and a ventricular ( n = 12) or aortic ( n = 1) wound [ 70 ]. Clamshell incision (CI) may be a superior approach over left anterolateral thoracotomy since it offers better exposure and does not take more time for inexperienced physicians performed in a cadaver model for surgical residents [ 73 ]. In the prehospital case series reported by Coats et al and Davies et al RT was exclusively done via CI [ 70 , 74 ].…”

Section: Resultsmentioning

confidence: 99%

Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting

Oostendorp

Tan²,

Geeraedts

2016

Scand J Trauma Resusc Emerg Med

105

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IntroductionExsanguination following trauma is potentially preventable. Extremity tourniquets have been successfully implemented in military and civilian prehospital care. Prehospital control of bleeding from the torso and junctional area’s remains challenging but offers a great potential to improve survival rates. This review aims to provide an overview of potential treatment options in both clinical as preclinical state of research on truncal and junctional bleeding. Since many options have been developed for application in the military primarily, translation to the civilian situation is discussed.MethodsMedline (via Pubmed) and Embase were searched to identify known and potential prehospital treatment options. Search terms were|: haemorrhage/hemorrhage, exsanguination, junctional, truncal, intra-abdominal, intrathoracic, intervention, haemostasis/hemostasis, prehospital, en route, junctional tourniquet, REBOA, resuscitative thoracotomy, emergency thoracotomy, pelvic binder, pelvic sheet, circumferential. Treatment options were listed per anatomical site: axilla, groin, thorax, abdomen and pelvis Also, the available evidence was graded in (pre) clinical stadia of research.ResultsIdentified treatment options were wound clamps, injectable haemostatic sponges, pelvic circumferential stabilizers, resuscitative thoracotomy, resuscitative endovascular balloon occlusion of the aorta (REBOA), intra-abdominal gas insufflation, intra-abdominal self-expanding foam, junctional and truncal tourniquets. A total of 70 papers on these aforementioned options was retrieved. No clinical reports on injectable haemostatic sponges, intra-abdominal insufflation or self-expanding foam injections and one type of junctional tourniquets were available.ConclusionOptions to stop truncal and junctional traumatic haemorrhage in the prehospital arena are evolving and may offer a potentially great survival advantage. Because of differences in injury pattern, time to definitive care, different prehospital scenario’s and level of proficiency of care providers; successful translation of various military applications to the civilian situation has to be awaited. Overall, the level of evidence on the retrieved adjuncts is extremely low.

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Section: Resultsmentioning

confidence: 99%

Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting

Oostendorp

Tan²,

Geeraedts

2016

Scand J Trauma Resusc Emerg Med

105

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“…In the emergency situation, clamshell thoracotomy provides the best exposure and enables fastest control of thoracic injuries compared with other incisions, such as left anterolateral thoracotomy 11. The clamshell incision allows access to both thoracic cavities, the lower mediastinum and heart.…”

Section: Discussionmentioning

confidence: 99%

Life-saving emergency clamshell thoracotomy with damage-control laparotomy

Farooqui¹,

Cunningham

Morse

et al. 2019

BMJ Case Rep

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Clamshell thoracotomy for thoracic injuries is an uncommon emergency department procedure. The survival rates following emergency thoracotomy are very low at 9%–12% for penetrating trauma and 1%–2% for blunt trauma. We report an unusual case of survival after emergency department clamshell thoracotomy for penetrating thoracic trauma with cardiac tamponade in a 23-year-old man with multiple stab wounds on the chest and abdomen. The patient was awake and alert on arrival in the emergency department. Bilateral chest decompression by needle thoracostomy released air and blood. During subsequent chest drain insertion, the patient suddenly deteriorated and arrested. Clamshell thoracotomy was performed, and sinus rhythm restored before transfer to theatre. Following repair of the thoracic injuries, a midline laparotomy was performed as bleeding was suspected from the abdomen and a splenic injury repaired. The patient survived and has made a full recovery. This case demonstrates how clamshell thoracotomy can be a life-saving procedure.

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“…Specifically for blunt trauma CST, there is at least 1 case report encouraging resuscitative in‐hospital CST in blunt trauma. CST would allow faster and better access to thoracic organs for diagnosis and intervention, which might support even better outcome, compared to other thoracotomy techniques . Herein, rapid thoracic organ access should support a faster reversal of cardiac arrest, protecting cerebral perfusion, and limit hypoxic damage.…”

Section: Discussionmentioning

confidence: 99%

Emergency clamshell thoracotomy in blunt trauma resuscitation: Shelling the paradigm‐2 cases and review of the literature

Schober

Leeuw

Terra

et al. 2018

Clinical Case Reports

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Clamshell Incision Versus Left Anterolateral Thoracotomy. Which One is Faster When Performing a Resuscitative Thoracotomy? The Tortoise and the Hare Revisited

Abstract: The time needed from skin incision until cardiac wound control via CI was not longer than via LAT and the easier control of the cardiac wound when using CI was confirmed.

Cited by 41 publications

References 37 publications

Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting

Prehospital control of life-threatening truncal and junctional haemorrhage is the ultimate challenge in optimizing trauma care; a review of treatment options and their applicability in the civilian trauma setting

Life-saving emergency clamshell thoracotomy with damage-control laparotomy

Emergency clamshell thoracotomy in blunt trauma resuscitation: Shelling the paradigm‐2 cases and review of the literature

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