This concept of mini-operations on the open heart is based on the so-called "clamshell thoracotomy." In this procedure, patients who have suffered cardiac arrest have their chest opened to provisionally treat life-threatening injuries, explained Chief Physician Mario Krammel in a background discussion.

Vienna Professional Rescue Service a Pioneer in Mini-Open Heart Operations Nationwide

The method, reminiscent of "opening a clamshell," is still relatively new in Austria but has already been adopted in emergency services in London and Berlin. "We saw this in Berlin ten years ago and considered how we could bring this training to Vienna," said Emergency Physician Krammel, one of the initiators at the Professional Rescue Service. Now, "clamshell thoracotomies" can be performed throughout the capital as needed. So far, 100 emergency physicians and 80 paramedics have been trained, with more to follow. The Professional Rescue Service is thus a pioneer nationwide. "We are venturing into a field that has not been widely practiced in preclinical care in this form," added a spokesperson. Such treatment is always performed only by experienced emergency physicians, with medical personnel assisting.

Mini-Open Heart Operations an "Absolute Emergency Measure, We Are Not Surgeons" Says Chief Physician

Key indications for such treatment are life-threatening gunshot or stab wounds to the heart, lungs, or other major vessels in conjunction with cardiac arrest. However, for patients with "impalement injuries such as those from a construction site accident," a "clamshell thoracotomy" is also a possible application. Specifically, the procedure involves a horizontal incision between the ribs. In the second step, provisional treatment of internal injuries occurs - including internal cardiac massage and sutures. For this, the physicians of the Professional Rescue Service themselves take needle and thread in hand, with Krammel making a conscious effort to differentiate: "We are not surgeons." The comprehensive introduction of the procedure is not intended to foster competition. "What we are doing here is truly an absolute emergency measure within the framework of resuscitation when the heart has stopped beating." Often, seconds are crucial in determining a patient's life or death, Krammel explained to the APA.

Survival Rate for Mini-Open Heart Operations at 35 Percent

Past experiences in emergency services have shown that acute blood loss, lung collapse, oxygen deficiency, or blood accumulation in the pericardium often lead to a - often ultimately fatal - cardiac arrest. "And in such cases, heart massage and the defibrillator are of no use. We cannot help our patients in any other way - except with this emergency measure, to then bring them to the hospital as quickly as possible," said Krammel. "Otherwise, they would have no chance of survival." He referred to studies on the survival rate after a "clamshell thoracotomy" following cardiac arrest due to a heart injury. According to these, 35 percent of those treated survived due to such treatment. In 2022, after years of consideration, the start of a training project for the "clamshell thoracotomy" finally took place.

In January 2023, the Professional Rescue Service had to resort to the new measure for the first time. A 60-year-old man had loudly knocked on his neighbor's door with a firearm in Kienmayergasse in Penzing. After a subsequent shootout with the police, the man was shot by Cobra officers and ultimately died despite emergency treatment. In total, three operations with clamshell thoracotomy were recorded in 2023. In 2024, treatments were performed on five individuals. Two of them survived their injuries, most recently a young mother of two in August 2024 in Vienna-Penzing after life-threatening stab wounds. "And that's exactly why we do it."

(APA/Red)

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