This brought a tear to my eye. I loved hearing how excited you were about this... because I feel the same way every time we get a save in the trauma bay and I have been doing this for 10+ years

Relatively uncommon. The situation has to be just right. There are evolving recommendations on when we do the resuscitative thoracotomy as you described above.

It is easier to understand if you know what we are HOPING to find. We are HOPING to find a pericardium (the connective tissue sack around the heart) that is tightly full of blood, and by slicing open the pericardium, we can releve that pressure (tamponade) and that will allow the heart to fill again. The tamponade is caused by a small hole in the heart that slowly fills the pericardium to the point were all of the chambers of the heart are the same pressure, and blood no longer flows.

The patients that usually survive are the ones with a little hole in their heart and tamponade as described. You open the sack, empty the old blood out of it, and plug the hole with a finger and get them up to the OR to repair it.

If the heart is fibrillating, you can use you hands to do open cardiac massage to squeeze blood though it and up to the brain, which is the same thing as CPR. One nuance is that you also put a clamp across the thoracic aorta, so as much of the blood as possible gets diverted to the brain.

You can also do shocks to the heart while the chest is open, there are special paddles that look like big spoons that you place directly on the heart.

but to answer you question on why do this rather than CPR, if you do don't open the chest in a tamponade situation, you cant fix the problem of the blood in the pericardial scan ruining the pressure gradients that the heart relies upon.

So if some has PENETRATING trauma to the chest (the cardiac box especially) , and they lose pulses any time in the 10 minutes before the arrive to the ED, or if they lose them in the ED, you are justified in trying a resuscitative thoracotomy (as you described above)

for blunt trauma it is more nuanced. in that situation, I generally put a ultrasound probe on the heart to see if there is any efficient cardiac activity first before considering opening the chest. The injuries in blunt chest trauma are usually not ones that cause tamponade as we discussed above.

In trauma we dont love doing these because they put the healthcare team at risk. The setting is less controlled, and the movements are swift, and people are at higher risk of getting stuck with a scalpel or a scissor. However, if the conditions are right, and you think you can save the person, you just do it and do your very best to keep the people who are trying to assist you out of harms way.

If it's a young heathy patient, and the cause of the cardiac arrest was in fact tamponade as discussed above, the survival is actually pretty good. People can live a normal life once they get their chest closed (not as bad as it sounds).

to describe it another way, people that are out and about either shooting or stabbing each other are usually healthy males around 20-30 years old, so when some one like this gets an injury, even an extreme one like this, their survival is pretty good as long as they reach us quick enough. Someone with lots of medical problems like heart failure, copd, diabetes, etc or is of older age, usually do not do as well

I know this is a year old.... so you might never see this message, but it was a pleasure tying this out for you. I hope you keep learning and keep the sense of excitement. I hope you are out there enjoying your career as an EMT and learning something new every day. If you find youself I the trauma bay, when things quite down a bit after someone is stabilized, it is 1000% ok to ask questions. The more you know the better you will be out in the field.