Comparison of Two Resuscitative Thoracotomy Techniques

Brooke Army Medical Center

Status: Completed

Conditions: Procedural Training; Emergencies; Thoracotomy; Trauma

Treatments: Other: Left Anterolateral Thoracotomy; Other: Modified Clamshell Thoracotomy

Study type: Interventional

Funder types: Other; Other U.S. Federal agency

Identifiers

NCT04242160

C.2017.172e

Details and patient eligibility

About

Resuscitative thoracotomy (RT) is a life saving procedure for patients who have suffered cardiac arrest or are at significant risk of cardiac arrest following significant trauma. The procedure is ideally performed by a surgeon, but in some circumstance must be performed by non-surgical specialists such as Emergency Medicine physicians. The purpose of this study was to evaluate the optimal RT technique taught to non-surgical specialists in an educational human cadaver lab. The objective was to compare time to successful completion of two different RT techniques; (1) Left Anterolateral Thoracotomy (LAT) and (2) Modified Clamshell Thoracotomy (MCT). The investigators hypothesized that the non-surgical specialist time to successful completion for the MCT would be shorter than for the LAT.

Full description

The investigators conducted a randomized crossover trial of two resuscitative thoracotomy techniques performed by Emergency Medicine (EM) physicians using a fresh human cadaver model. The purpose was to identify the ideal technique to be taught to non-surgical specialists in a training lab setting. The two techniques compared were the Left Anterolateral Thoracotomy (LAT), commonly taught to EM physicians in the United States, and the Modified Clamshell Thoracotomy (MCT) taught by London's Air Ambulance. The investigators hypothesized that the non-surgical specialists time to successful completion of the RT would be faster when performing the MCT compared to the LAT.

The investigators conducted this study at a large level 1 trauma center with an Emergency Medicine residency program and recruited Emergency Medicine residents and staff physicians to participate. Participants were trained on the MCT as performed by LAA and reviewed the LAT technique in a standardized fashion. Participants were then randomized to order of intervention, and conducted each procedure on a separate fresh human cadaver. Participants were evaluated on time to successful completion of the procedure, successful completion of procedural steps, and identification of anatomy. Cadaver specimens were examined for iatrogenic injuries. Participants then completed a standardized survey regarding each procedure.

Enrollment: 15 patients

Sex: All

Volunteers: Accepts Healthy Volunteers

Inclusion criteria

• licensed physician
• emergency medicine residency trainee or graduate
• privileged provider at SAMMC

Exclusion criteria

• unwilling to participate

Trial design

Primary purpose: Other

Allocation: Randomized

Interventional model: Crossover Assignment

Masking: None (Open label)

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15 participants in 2 patient groups

Modified Clamshell Thoracotomy First

Experimental group

Description:

Participants randomized to perform the MCT first, then cross over to the perform the alternate LAT.

Treatment:

Other: Left Anterolateral Thoracotomy

Other: Modified Clamshell Thoracotomy

Left Anterolateral Thoracotomy First

Active Comparator group

Description:

Participants randomized to perform the LAT first, then cross over to the perform the alternate MCT.

Treatment:

Other: Left Anterolateral Thoracotomy

Other: Modified Clamshell Thoracotomy