{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T12:10:53Z","timestamp":1783944653259,"version":"3.55.0"},"reference-count":20,"publisher":"BMJ","issue":"7","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ Case Rep"],"accepted":{"date-parts":[[2026,6,17]]},"published-print":{"date-parts":[[2026,7]]},"abstract":"<jats:p>The resuscitative thoracotomy (RT) is a time-sensitive procedure performed on trauma patients with impending fatality, particularly those with penetrating thoracic injuries. We present a case of a male in his twenties with pulseless electrical activity following a gunshot wound (GSW) to the right chest. This patient experienced rapid haemodynamic deterioration in concurrence with signs of cardiac tamponade, leading to the performance of a clamshell thoracotomy, followed by a pericardiotomy, and subsequent myocardial repair. Direct haemorrhage control, cardiac massage and rapid transfusion achieved return of spontaneous circulation (ROSC) in the emergency department (ED). The patient survived neurologically intact after definitive surgical repair. This case underscores RT\u2019s life-saving potential when executed promptly for penetrating trauma with pericardial tamponade or haemorrhage. While mortality remains high, survival hinges on immediate intervention, surgical expertise and coordinated resuscitation. When indicated, this aggressive procedure remains the only chance for survival in otherwise fatal injuries.<\/jats:p>","DOI":"10.1136\/bcr-2025-269728","type":"journal-article","created":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:35:15Z","timestamp":1783942515000},"page":"e269728","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":0,"title":["Resuscitation following emergency room clamshell thoracotomy and cardiac laceration repair"],"prefix":"10.1136","volume":"19","author":[{"ORCID":"https:\/\/orcid.org\/0009-0002-7902-279X","authenticated-orcid":false,"given":"Abigail","family":"Ellstrom","sequence":"first","affiliation":[{"name":"Department of Surgery, Texas Christian University Anne Burnett Marion School of Medicine, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniella","family":"Natanov","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Health Resources, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas","family":"Scully","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Health Resources, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hashim","family":"Ahmed","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Health Resources, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Craig Owen","family":"Daniel","sequence":"additional","affiliation":[{"name":"Department of Surgery, Texas Health Resources, Fort Worth, Texas, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2026,7,13]]},"reference":[{"key":"2026071304350589000_19.7.e269728.1","doi-asserted-by":"crossref","first-page":"1082","DOI":"10.1016\/j.amjsurg.2020.09.038","article-title":"Emergency Department Resuscitative Thoracotomy: Indications, surgical procedure and outcome. A narrative review","volume":"221","author":"Aseni","year":"2021","journal-title":"Am J Surg"},{"key":"2026071304350589000_19.7.e269728.2","doi-asserted-by":"publisher","DOI":"10.1016\/j.injury.2005.02.014"},{"key":"2026071304350589000_19.7.e269728.3","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(99)00233-1"},{"key":"2026071304350589000_19.7.e269728.4","doi-asserted-by":"crossref","first-page":"4877","DOI":"10.1007\/s00068-022-02021-x","article-title":"Outcomes of the resuscitative and emergency thoracotomy at a Dutch level-one trauma center: are there predictive factors for survival?","volume":"48","author":"Sam","year":"2022","journal-title":"Eur J Trauma Emerg Surg"},{"key":"2026071304350589000_19.7.e269728.5","doi-asserted-by":"crossref","DOI":"10.1186\/s13049-020-0705-4","article-title":"Outcomes following resuscitative thoracotomy for abdominal exsanguination, a systematic review","volume":"28","author":"Hughes","year":"2020","journal-title":"Scand J Trauma Resusc Emerg Med"},{"key":"2026071304350589000_19.7.e269728.6","doi-asserted-by":"crossref","DOI":"10.1038\/s41598-023-43318-0","article-title":"Potential harms of emergency department thoracotomy in patients with persistent cardiac arrest following trauma: a nationwide observational study","volume":"13","author":"Yamamoto","year":"2023","journal-title":"Sci Rep"},{"key":"2026071304350589000_19.7.e269728.7","unstructured":"Emergency Department Thoracotomy - Practice Management Guideline. Available: https:\/\/www.east.org\/education-resources\/practice-management-guidelines\/details\/emergency-department-thoracotomy [Accessed 15 Jul 2025]."},{"key":"2026071304350589000_19.7.e269728.8","doi-asserted-by":"crossref","first-page":"4","DOI":"10.1186\/1749-7922-1-4","article-title":"Emergency department thoracotomy for the critically injured patient: Objectives, indications, and outcomes","volume":"1","author":"Cothren","year":"2006","journal-title":"World J Emerg Surg"},{"key":"2026071304350589000_19.7.e269728.9","doi-asserted-by":"publisher","DOI":"10.1016\/S1072-7515(01)00999-1"},{"key":"2026071304350589000_19.7.e269728.10","doi-asserted-by":"publisher","DOI":"10.1097\/00005373-200104000-00012"},{"key":"2026071304350589000_19.7.e269728.11","unstructured":"Weare S , Gnugnoli DM . Emergency room thoracotomy. Treasure Island (FL): StatPearls Publishing, 2025."},{"key":"2026071304350589000_19.7.e269728.12","article-title":"An Emergency Adaptation of Anterolateral and Clamshell Thoracotomy for Blunt Traumatic Right Atrial Rupture: A Case Report","volume":"15","author":"Alfraidy","year":"2023","journal-title":"Cureus"},{"key":"2026071304350589000_19.7.e269728.13","doi-asserted-by":"crossref","first-page":"509","DOI":"10.1016\/j.amj.2020.08.001","article-title":"Clamshell in a Heartbeat","volume":"39","author":"Vreeswijk","year":"2020","journal-title":"Air Med J"},{"key":"2026071304350589000_19.7.e269728.14","doi-asserted-by":"crossref","DOI":"10.1136\/bcr-2018-227879","article-title":"Life-saving emergency clamshell thoracotomy with damage-control laparotomy","volume":"12","author":"Farooqui","year":"2019","journal-title":"BMJ Case Rep"},{"key":"2026071304350589000_19.7.e269728.15","doi-asserted-by":"crossref","DOI":"10.11622\/smedj.2015124","article-title":"The \u201cclamshell\u201d approach to emergency department thoracotomy","volume":"56","author":"Goh","year":"2015","journal-title":"Singapore Med J"},{"key":"2026071304350589000_19.7.e269728.16","article-title":"Resuscitative Thoracotomy for Multiple Gunshot Wounds With Cardiac Tamponade Despite Pericardial Window","volume":"12","author":"Kostick","year":"2020","journal-title":"Cureus"},{"key":"2026071304350589000_19.7.e269728.17","doi-asserted-by":"crossref","first-page":"2468","DOI":"10.1177\/00031348221101479","article-title":"Atrial Cannulation During Resuscitative Clamshell Thoracotomy","volume":"89","author":"Willis","year":"2023","journal-title":"Am Surg"},{"key":"2026071304350589000_19.7.e269728.18","doi-asserted-by":"crossref","DOI":"10.3390\/antibiotics9100700","article-title":"Dalbavancin in the Treatment of Bacteremia and Endocarditis in People with Barriers to Standard Care","volume":"9","author":"Ajaka","year":"2020","journal-title":"Antibiotics (Basel)"},{"key":"2026071304350589000_19.7.e269728.19","first-page":"106827","article-title":"Comparison of dalbavancin with standard of care in the management of infective endocarditis: efficacy, safety, and cost analysis","volume":"140","author":"Su\u00e1rez","year":"2024","journal-title":"Int J Infect Dis"},{"key":"2026071304350589000_19.7.e269728.20","unstructured":"Cheatham MM . Resuscitative thoracotomy. 2024."}],"container-title":["BMJ Case Reports"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/syndication.highwire.org\/content\/doi\/10.1136\/bcr-2025-269728","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,7,13]],"date-time":"2026-07-13T11:35:17Z","timestamp":1783942517000},"score":1,"resource":{"primary":{"URL":"https:\/\/casereports.bmj.com\/lookup\/doi\/10.1136\/bcr-2025-269728"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,7]]},"references-count":20,"journal-issue":{"issue":"7","published-online":{"date-parts":[[2026,7,13]]},"published-print":{"date-parts":[[2026,7]]}},"alternative-id":["10.1136\/bcr-2025-269728"],"URL":"https:\/\/doi.org\/10.1136\/bcr-2025-269728","relation":{},"ISSN":["1757-790X"],"issn-type":[{"value":"1757-790X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,7]]}}}