Clamshell thoracotomy after single stab with a knife in the cardiac box

Abstract

Case reports on performing a preclinical clamshell thoracotomy in Germany are rare, although this emergency procedure is included in international guidelines for the treatment of traumatic cardiac arrest. This article is a case report of an adult patient who was stabbed with a knife in the area of the thorax known as the cardiac box. Conventional measures of cardiopulmonary resuscitation, such as securing the airway, ventilation and chest compression did not lead to a return of spontaneous circulation (ROSC). Even after the exclusion of a tension pneumothorax by mini-thoracotomy, no permanent ROSC could be established; therefore, a thoracotomy was considered and performed on site in accordance with the guideline recommendations. After evacuation of a pericardial tamponade and subsequent ROSC, a severely bleeding myocardial injury was sutured and the patient was taken to the trauma room of Heidelberg University Hospital. There, an emergency transfusion and subsequently the definitive repair of the injury was performed in the cardiosurgical operating room. The patient died the following day in the company of his relatives from the sequelae of hypoxic cerebral edema.