A Clamshell (bilateral anterior) thoracotomy performed due to a high-velocity round to the chest that went through from right to left crossing the midline!
The bullet when through both left and right lung hilum.
The survival rate is extremely low, but we have to try, and we do. We have had patients survive and we will attempt to give anyone a chance at life. Sometimes it makes all the difference in the world.
This patient lost pulses in the ambulance and the decision to open the chest was made before the patient arrived.
Unfortunately, the patient did not survive after this attempt to save his life.
A clamshell thoracotomy provides almost complete exposure to both thoracic cavities. In general, the indications for performing a clamshell thoracotomy are when you need access to both sides of the chest, or just when you need better access than a unilateral thoracotomy can give you.
This emergency thoracotomy is performed by surgeons to gain access to the thoracic organs, most commonly the heart, lungs, or oesophagus, or for access to the thoracic aorta or the anterior spine (the latter necessary in case of tumours in the spine), mainly to control injury-related bleeding from the heart, cardiac compressions to restore a normal heart rhythm, or to relieve pressure on the heart caused by cardiac tamponade (accumulation of fluid in the space between the heart's muscle and outer lining) to resuscitate a patient who is near death as a result of a chest injury.
Overall, a clamshell incision is a good first choice for ED thoracotomy. It provides rapid and easy access to all structures within the thoracic cavity with one incision; improved visualisation, assessment and identification of injuries within the thorax; and quick manipulation of the thoracic structures.