Description of procedure: The patient was supine with the left arm abducted above the head. The left chest was rapidly prepped with betadine splash. A left anterolateral incision was made in the 4th/5th intercostal space from the sternal border to the posterior axillary line/bed, following the inframammary fold. The intercostal muscles were divided with curved Mayo scissors along the superior border of the lower rib. A Finocchietto retractor was placed with the handle toward the axilla. [The inferior pulmonary ligament was divided and the lung retracted superiorly.]
Findings on entry: [1000 mL] blood in left hemithorax / [empty heart with no motion].
The pericardium was tented with forceps and incised anterior and parallel to the left phrenic nerve, there was no blood noted. The descending thoracic aorta was identified above the diaphragm and clamped. Two-handed open cardiac massage was performed while blood was transfused from IO catheter. ER MD placed a right chest tube with no blood obtained.