Resuscitative thoracotomies and open chest cardiac compressions in non-traumatic cardiac arrest

Since the popularisation of closed chest cardiac compressions in the 1960s, open chest compressions in non-traumatic cardiac arrest have become a largely forgotten art. Today, open chest compressions are only rarely performed outside operating theatres. Early defibrillation and high quality closed chest compressions is the dominating gold standard for the layman on the street as well as for the resuscitation specialist. In this paper we argue that the concept of open chest direct cardiac compressions in non-traumatic cardiac arrest should be revisited and that it might be due for a revival. Numerous studies demonstrate how open chest cardiac compressions are superior to closed chest compressions in regards to physiological parameters and outcomes. Thus, by incorporating resuscitative thoracotomies and open chest compressions in our algorithms for non-traumatic cardiac arrest we may improve outcomes.