- Left anterolateral thoracotomy with cross-clamping of the descending thoracic aorta and open cardiac massage to control massive intra-abdominal bleeding, page 1
- Steps
- Retract the left lung superiorly.
- Divide the inferior pulmonary ligament.
- Palpate the orogastric or nasogastric tube (if present) to differentiate the esophagus from the empty descending aorta.
- Perform the periaortic dissection at the level of an intervertebral space in a plane perpendicular to the aorta to avoid injսrу to intercostal vessels, which branch from the aorta at the level of the mid-vertebral body (figure below)
- Incise the parietal pleura overlying the aorta and separate the tissues between the aorta and esophagus, as well as the prevertebral fascia to create sufficient space to place the aortic clamp without avulsing the intercostal arteries from the posterior surface of the aorta.
- The aorta should be cross-clamped at the most distal location that is practical to preserve Spinal cord blood supply
- Benefits
- Vital organ perfusion → Heart, Brain
- Limit infra-diaphragmatic haemorrhage
- Note time - should be < 30 mins
