Even though the technique of resuscitative thoracotomy belongs predominantly in the domain of emergency medicine, the College of Intensive Care Medicine has recently included it as a 70%-weighted part of Question 10 from the first paper of 2016. This is perhaps in response to the idea that opening the chest is a resuscitative step in scenarios outside of trauma. For instance, reopening the sternum is the final common pathway of the post-cardiac-surgery arrest algorithm, and opening the pericardium is one of the last-ditch measures to improve cardiac output in otherwise refractory cardiogenic shock. Prior to the advent of effective external cardiac compression training, internal cardiac massage was used to resuscitate patients who had collapsed from medicla causes. That said, this chapter focuses mainly on the applications of resuscitative thoracotomy to acute chest trauma.
This heroic act is certainly a favourite among adrenaline-loving emergency jocks, because it is represents the hottest sexiest form of maximally aggressive resuscitation. You open the chest and save the patient's life, goddamnit. Whatever the outcome at the end, as you wipe the blood from your face the junior nurses swoon, bowled over by the pulsating waves of your raw masculinity.
As far as published literature goes, there is plenty to look at. LITFL have a wonderfully gory article about this practice, engaging the important question of whether or not it represents the initial stages of an autopsy.
"Resuscitative thoracotomy" or "emergency department thoracotomy" refers to a left-sided clamshell thoracotomy performed for the specific purpose of gaining rapid access to the heart and major thoracic vessels.
Characteristic features which define the procedure include:
Morrison, Jonathan J., et al. "Resuscitative thoracotomy following wartime injury." Journal of Trauma and Acute Care Surgery 74.3 (2013): 825-829.
Burlew, Clay Cothren, et al. "Western Trauma Association critical decisions in trauma: resuscitative thoracotomy." Journal of Trauma and Acute Care Surgery 73.6 (2012): 1359-1363.
Ohrt-Nissen, S., et al. "Indication for resuscitative thoracotomy in thoracic injuries—Adherence to the ATLS guidelines. A forensic autopsy based evaluation." Injury 47.5 (2016): 1019-1024.
Rabinovici, Reuven, and N. Bugaev. "Resuscitative thoracotomy: an update." Scandinavian Journal of Surgery (2014): 1457496913514735.
CALS program manual: "Emergency Thoracotomy (Circulation Skills 4)"
Working Group, Ad Hoc Subcommittee on Outcomes. "Practice management guidelines for emergency department thoracotomy." Journal of the American College of Surgeons 193.3 (2001): 303-309.
Keller, Deborah, et al. "Life after near death: long-term outcomes of emergency department thoracotomy survivors." Journal of Trauma and Acute Care Surgery 74.5 (2013): 1315-1320.