Indications for Thoracotomy in Trauma

Resuscitative Emergency Thoracotomy

The American College of Surgeons recommends thoracotomy for resuscitative purposes in cardiac arrest or impending cardiac arrest occurring within 15 minutes of onset, caused by penetrating or blunt trauma, with a left-sided anterolateral incision or clamshell approach for optimal exposure 1, 2, 4
The procedure must be performed with concurrent blood transfusions, fluid resuscitation, and anti-shock treatment, including open pleura and pericardium, clamping injured aorta, and performing intrathoracic CPR 1, 2, 4

The Eastern Association for the Surgery of Trauma recommends immediate surgical intervention for massive progressive hemorrhage, with initial chest tube drainage >1000 mL or ongoing drainage >200 mL/hour for >3 hours despite anti-shock treatment 1, 4, 3
The Society of Critical Care Medicine recommends surgical options for severe pulmonary laceration, including repair, lobectomy, segmentectomy, or hilar torsion for temporary control, when closed thoracic drainage fails to relieve dyspnea or there is continuous hemorrhage despite chest tube placement 1, 2, 4
The American Heart Association recommends surgical intervention for cardiac injuries, including pericardial tamponade with Beck's triad, severe heart contusion, and penetrating cardiac injuries with hemodynamic instability 1, 2, 4, 5
The American College of Surgeons recommends surgical intervention for major airway injuries, including severe tracheal and bronchial injuries when tracheotomy and closed drainage cannot alleviate dyspnea 1, 2, 4

The European Society of Thoracic Surgeons recommends an anterolateral left thoracotomy as the initial approach for most damage control situations, providing access to pericardium, descending aorta, and left hilum 1, 2, 4, 5
The Society of Thoracic Surgeons recommends a clamshell extension when bilateral exposure is needed or there is inadequate visualization 1, 2, 5
The American Association for Thoracic Surgery recommends a median sternotomy for isolated cardiac and great vessel injuries 1, 4