title: Clamshell thoracotomy and open heart massage--A potential life-saving procedure can be taught to emergency physicians: An educational cadaveric pilot study.
abstract: OBJECTIVE
  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.
  
  
  CONCLUSIONS
  Clamshell thoracotomy can be taught using cadaver models. In this simulated environment, the procedure may be performed rapidly with minimum equipment.
authors.affiliation: Medical University of Graz, Department for Traumatology, Auenbruggerplatz 5, 8036 Graz, Austria. Electronic address: paul.puchwein@medunigraz.at.
authors.forename: Paul
authors.initials: P
authors.lastname: Puchwein
authors.affiliation: Medical University of Graz, Department for Traumatology, Auenbruggerplatz 5, 8036 Graz, Austria.
authors.forename: Florian
authors.initials: F
authors.lastname: Sommerauer
authors.affiliation: Unfallkrankenhaus Graz, Göstinger Straße 24 8020 Graz, Austria.
authors.forename: Hans G
authors.initials: HG
authors.lastname: Clement
authors.affiliation: Unfallkrankenhaus Graz, Göstinger Straße 24 8020 Graz, Austria.
authors.forename: Veronika
authors.initials: V
authors.lastname: Matzi
authors.affiliation: Medical University of Graz, Institute of Anatomy, Harrachgasse 21, 8010 Graz, Austria.
authors.forename: Norbert P
authors.initials: NP
authors.lastname: Tesch
authors.affiliation: Medical University of Graz, Department for Anaesthesiology and Intensive Care, Auenbruggerplatz 29, 8036 Graz, Austria.
authors.forename: Barbara
authors.initials: B
authors.lastname: Hallmann
authors.affiliation: Queen Mary University of London and Barts Health NHS Trust, Whitechapel, London, UK.
authors.forename: Tim
authors.initials: T
authors.lastname: Harris
authors.affiliation: Medical University of Graz, Department for Anaesthesiology and Intensive Care, Auenbruggerplatz 29, 8036 Graz, Austria.
authors.forename: Marcel
authors.initials: M
authors.lastname: Rigaud
mesh_terms: D002102:Cadaver; D002305:Cardiac Tamponade / Q000628:therapy*; D004632:Emergency Medical Services / Q000379:methods*; D004635:Emergency Medicine / Q000193:education*; D005260:Female; D006323:Heart Arrest / Q000628:therapy*; D006336:Heart Massage / Q000379:methods*; D006801:Humans; D007396:Internship and Residency; D008297:Male; D061646:Operative Time; D010865:Pilot Projects; D012151:Resuscitation / Q000193:education* / Q000379:methods; D013908:Thoracotomy / Q000193:education* / Q000379:methods
keywords: Clamshell thoracotomy; Emergency thoracotomy; Resuscitative thoracotomy