Clamshell thoracotomy and open heart massage—A potential life-saving procedure can be taught to emergency physicians

Autor: Veronika Matzi, Paul Puchwein, Norbert Peter Tesch, Tim Harris, Florian Sommerauer, Barbara Hallmann, Marcel Rigaud, Hans Clement
Rok vydání: 2015
Předmět:
Zdroj: Injury. 46:1738-1742
ISSN: 0020-1383
DOI: 10.1016/j.injury.2015.05.045
Popis: Aims Selected patients in traumatic cardiac arrest may benefit from pre-hospital thoracotomy. Pre-hospital care physicians rarely have surgical training and the procedure is rarely performed in most European systems. Limited data exists to inform teaching and training for this procedure. We set out to run a pilot study to determine the time required to perform a thoracotomy and the a priori defined complication rate. Methods We adapted an existing system operating procedure requiring four instruments (Plaster-of-Paris shears, dressing scissors, non-toothed forceps, scalpel) for this study. We identified a convenience sample of surgically trained and non-surgically trained participants. All received a training package including a lecture, practical demonstration and cadaver experience. Time to perform the procedure, anatomical accuracy and a priori complication rates were assessed. Results The mean total time for the clamshell thoracotomy from thoracic incision to delivery of the heart was 167 s (02:47 min:sec). There was no statistical difference in the time to complete the procedure or complication rate among surgeons, non-surgeons and students. The complication rate dropped from 36% in the first attempt to 7% in the second attempt but this was not statistically significant. This is a pilot study and small numbers of participants arguably saw it underpowered to define differences between study groups. Conclusion Clamshell thoracotomy can be taught using cadaver models. In this simulated environment, the procedure may be performed rapidly with minimum equipment.
Databáze: OpenAIRE
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