Resuscitative Thoracotomy After Thoracic Gunshot Wound

Thoracic gunshot injuries present with variable manifestations, and treatment differs accordingly. The mortality rate following a cardiac gunshot injury is approximately 80%. Clamshell thoracotomy for thoracic injuries is an uncommon procedure performed in emergency settings. Survival rates following emergency thoracotomy are notably low: 9%–12% for penetrating trauma and 1%–2% for blunt trauma. This case report details the experience of a 31-year-old male who presented with hemorrhagic shock and respiratory compromise following a gunshot wound to the back of the chest. Despite initial resuscitation efforts, including rapid sequence intubation, bilateral chest tube insertion, and activation of a massive blood transfusion protocol, the patient developed cardiopulmonary arrest. An AMPLE history could not be obtained. A resuscitative clamshell thoracotomy was performed in the "R Room" with minimal resources. Intraoperative findings included a defect greater than 1 cm in the ascending aorta and a rupture of the left ventricle. Two-handed open cardiac massage was performed, a Foley catheter was used to occlude the larger cardiac defect, and manual compression was applied to the ascending aorta to achieve hemostasis. Despite these maneuvers and 25 minutes of resuscitation, including intravenous adrenaline and intravenous noradrenaline infusion, the patient succumbed to massive bleeding. This case underscores the challenges and limited efficacy of resuscitative measures in severe thoracic trauma with significant cardiovascular involvement.