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Ann Thorac Surg 1995;60:120-121
© 1995 The Society of Thoracic Surgeons

Discussion

The first 20% of the full text of this article appears below.


   Introduction
 
See also page 117.

DR JAMES W. PATE (Memphis, TN):

I enjoyed this beautifully presented paper on an experience with a uniquely low mortality rate. Mortality between series varies tremendously, a fact primarily reflecting weapons used and delays. Our experience leads me to raise a few points.

Is the use of a pump-oxygenator necessary in emergency management of cardiac injuries? I think not; there are catastrophes when patients are transferred to a ``heart center.'' In the last 200+ patients when a pump-oxygenator has been available to our trauma center, it has been used two times for cardiac injuries. In 1 other patient, it may, in retrospect, have been of value. In this smaller series, the authors used extracorporeal circulation in 4 patients. In 1 patient, it was found to be unnecessary, as the foreign body turned out to be loose in the pericardium; in another, an intracardiac foreign body was removed as an emergency (of our six intracardiac foreign bodies, only one embolized, and that occurred late). One patient had aortic penetration and another, injury to the right coronary, which was repaired. There were 4 other patients with coronary injury that was not repaired or bypassed; 2 died before surgical intervention and 2 had ligation without complication. I must conclude that the data do not support the necessity for a pump-oxygenator in the emergency management of cardiac injuries.

Second, is pericardiocentesis useful? There was a dramatic improvement in survival with the introduction . . . [Full Text of this Article]






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Copyright © 1995 by The Society of Thoracic Surgeons.