• T Rogerson, T Efstratiades, U Von Oppell, G Davies, and R Curtin.
• Emergency Medical Retrieval and Transfer Service Wales, Llanelli, UK. Electronic address: tim.rogerson@wales.nhs.uk.
• Injury. 2020 Jan 1; 51 (1): 122-123.

AbstractBlunt trauma causing cardiac rupture is usually fatal. We report a patient with blunt cardiac injury that suffered traumatic cardiac arrest in the pre-hospital phase of their care. A cardiac tamponade was confirmed with portable ultrasound in a brief return of circulation. The patient had a further cardiac arrest and subsequently underwent damage control emergency surgery via a clamshell thoracotomy at the scene. The tamponade was released and a clamp was applied to the identified left atrial appendage rupture, a return of circulation then occurred. He was transferred to a cardiothoracic centre where a left atrial appendage rupture was identified and closed. The patient had a complicated recovery in hospital but went on to survive neurologically intact. This is the first documented case report of a neurologically intact survivor of a pre-hospital clamshell thoracotomy for blunt trauma. Although survivors of blunt trauma who have pre-hospital thoracotomy are extremely rare it should be considered in very specific circumstances.Crown Copyright © 2019. Published by Elsevier Ltd. All rights reserved.

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