ED Thoracotomy for Asthma?
After my last post on a patient with asthma who arrested in our ED, Prof Simon Carley (@EMManchester, St Emlyns, BestBETs and all round EM guru (but doesn’t know much about snake bites)) posted a comment suggesting ED thoracotomy for asthmatic arrest.
I’d never even thought of this as an intervention.
He linked to a case report of a patient who was found dead from asthma, who had a thoracotomy, got ROSC but died a few days down the track. I couldn’t find any other case reports in Google or Pubmed.
The idea makes sense. Release the excess intrathoracic pressure, you can manually deflate the lungs, you can manually cause the heart to pump.
One of the arguments against ED thoracotomy in smaller centres that unless it is a very straight forward right ventricular laceration, we probably wont have anyone with the skills to repair anything we find once we open the patient up. But in the asthmatic there is no lacerated pulmonary artery or similar wound to repair (other than the thoracotomy, of course) so we could potentially transfer the patient with an open chest.
And in a dead patient what have you got to lose?
I guess the question would be when do you do it? After 5 minutes of PEA? 10 minutes? 20 minutes? What is the longest period of CPR in asthma with a good outcome?
Download audio here (right-click and save or save as) or
Music: The First Cut is he Deepest. Rod Stewart. https://itunes.apple.com/nz/album/the-very-best-of-rod-stewart/id15106451
Thoracotomy image from: http://upload.wikimedia.org/wikipedia/commons/6/67/Emergency_Thoracotomy.png