North Texas Research Forum 2024



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North Texas


Medical City Plano


General Surgery

Document Type


Publication Date



trauma, blunt trauma, clamshell thoracotomy, resuscitative thoracotomy


Emergency Medicine | Medicine and Health Sciences | Surgery | Trauma


INTRODUCTION: The probability of survival is poor in patients who require a resuscitative thoracotomy, reported in the literature to be 9-20%. Outcomes are worse in patients who have suffered blunt trauma compared to penetrating trauma reported between 2-7%. Many studies have been done to evaluate clinical predictors of survival versus mortality. We present a case of high-mechanism blunt trauma with a high injury severity score of 34 who survived after an emergency clamshell thoracotomy with full neurological recovery. CASE PRESENTATION: This case highlights a 28-year-old male who arrived as a transfer to a level 1 trauma center following high mechanism blunt trauma with known right hemothorax and aortic transection. Initial interventions were arterial line placement, cordis central venous catheter placement, and massive transfusion protocol (MTP) activation. After losing pulses in the trauma bay, he underwent ACLS, right thoracotomy with extension to clamshell thoracotomy and was taken to the operating room for exploration and control of hemorrhage. His injuries included Bilateral atrial appendage injuries cardiac tamponade secondary to bilateral atrial appendage injuries, aortic transection, T2-T4 vertebral body fractures, left ribs 2-7 and right ribs 2-5 fractures, right femoral head fracture, left acetabular rim fracture. He was discharged home on hospital day 30 neurologically intact. LEARNING POINTS: The credit to his survival is multifactorial. He arrived at a level 1 trauma center with the capability for massive transfusion, which was able to give him a total of 90 units of blood products. Supplies were immediately available when needed. The nursing and support staff in the trauma bay were well-trained and performed their duties at the highest level of expectation. Furthermore, the collaboration between the ED physicians, RNs, support staff and the trauma team led to expeditious care without undue delays. Being prepared for a broad array of injuries in the trauma bay is paramount to a quick and efficient resuscitation. This includes having equipment (invasive lines, chest tubes, a rapid transfuser, and thoracotomy instruments) and ancillary staff (blood bank, radiology, and operating room) readily available as well as emergency room staff who are trained and proficient in techniques and procedures that may be required. Perhaps often overlooked, the collaboration between the ER staff, the EM physicians and the trauma team also contributes to a smooth, seamless resuscitation.

Original Publisher

HCA Healthcare Graduate Medical Education

Survival After Emergency Clamshell Thoracotomy with Bilateral Atrial Appendage Injuries



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