RAPID RIGHT ATRIAL CANNULATION FOR FLUID INFUSION DURING RESUSCITATIVE EMERGENCY DEPARTMENT THORACOTOMY

A simple rapid technique for cannulating the right atrium during a res uscitative Emergency Department thoracotomy (EDT) for exsanguinating t rauma is described. Following the thoracotomy and pericardiotomy, an o rdinary Foley urinary bladder balloon catheter is inserted into the ri ght atrial appendage for rapid, large volume normothermic blood and fl uid infusion. A method for simplifying this maneuver, as well as the p otential complications of over-resuscitation with myocardial distentio n and fluid overload, myocardial cooling, air embolism, and tricuspid valve occlusion are discussed. We recognize that this technique is rad ical and applicable to only a limited subset of severely injured patie nts, for example, victims of non-cardiac penetrating trauma who arrive at the hospital moribund or who arrest in the emergency center.