Resüsitatif Torakotomi
Özet
Resüsitatif torakotomi, travmatik kardiyak arrest veya derin hipovolemik şokta, kalbin ve intratorasik büyük damarların doğrudan kontrolünü sağlamak amacıyla uygulanan invaziv bir acil cerrahi prosedürdür. Bu girişimin temel amacı, potansiyel olarak fatal intratorasik hemorajinin cerrahi kontrolünü, perikardiyal tamponadın dekompresyonunu ve serebral ile koroner perfüzyonun sürdürülmesini sağlayarak hastaya yaşam şansı tanımaktır. Tarihsel kökenleri Birinci Dünya Savaşı’na dayanan bu girişim, özellikle penetran kardiyak yaralanmalarda sağkalım oranları üzerine yapılan çalışmalarla klinik literatürdeki yerini sağlamlaştırmıştır. Güncel yaklaşımlar arasında endovasküler resüsitatif balon oklüzyon (REBOA) ve ekstrakorporeal membran oksijenasyonu (ECMO) gibi alternatifler bulunsa da resüsitatif torakotomi, seçilmiş hasta popülasyonlarında halen kritik bir müdahale olma özelliğini korumaktadır. En güçlü endikasyonları penetran kardiyak yaralanmalar ve perikardiyal tamponad durumlarıdır. Buna karşın, künt travma vakalarında prognozun son derece kötü olduğu bilinmektedir. Prosedür için mutlak kontrendikasyonlar arasında uzamış kardiyak arrest (özellikle 15 dakikadan uzun), asistoli ritmi, ölümcül yaralanmaların varlığı ve uygun cerrahi altyapının bulunmaması yer alır. Yüksek mortalite ve morbidite oranları göz önüne alındığında, bu girişim sadece deneyimli cerrahi ekipler tarafından, titizlikle belirlenmiş endikasyonlar ve doğru zamanlama ile uygulanmalıdır.
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