Cardiorrhaphy in the emergency center

The acutely injured patient may require emergency thoracotomy as an integral part of resuscitation. In critical circumstances, thoracotomy in the emergency center for control of hemorrhage, cardiac massage, and direct repair of crucial injuries can be lifesaving. Such an approach may be required for urgent repair of cardiac injuries. Between January, 1970, and December, 1973, over 6,000 emergency operations were performed for blunt and penetrating trauma at Ben Taub General Hospital. Emergency thoracotomy was required in more than 400 cases. Of these, 148 patients required thoracotomy in the Emergency Center due to rapid deterioration in their clinical condition. Forty-eight of these patients had injury to the heart. This aggressive approach allowed salvage of 67.5 per cent of these critically wounded patients with cardiac injuries who had any sign of life on arrival at the hospital. Autotransfusion, emergency cardiopulmonary bypass, and fine-screen filtration of transfused blood have been valuable adjuncts to this lifesaving measure. Thoracotomy in the Emergency Center should be considered as a primary modality in the management of moribund patients with penetrating wounds of the chest.