SUCCESSFUL ROADSIDE RESUSCITATIVE THORACOTOMY - CASE-REPORT AND LITERATURE-REVIEW

Patients with injuries severe enough to require cardiopulmonary resusc itation (CPR) have a dismal prognosis. Time to surgical intervention i s a major determinant of outcome in moribund trauma patients who have a potential for survival. With the exception of endotracheal intubatio n during evacuation to surgical intervention, no other usual prehospit al procedures have been validated to affect outcome in such cases of e xtremis. This is a report of a case in which resuscitative surgical te chniques were extended successfully to the prehospital environment. Th e patient was a 30-year-old man in extremis after a stab wound to the left chest. Estimating a transport time of 15 minutes, a physician rid ing with the emergency medical service (EMS) crews elected to perform a resuscitative thoracotomy. Following digital aortic compression, the patient regained both blood pressure and consciousness by the time of arrival at the trauma center. A left lower lobectomy was then perform ed in the operating room. The patient recovered fully and was discharg ed home in 21 days, neurologically intact. Four years later, the patie nt was alive, healthy, and working. This report demonstrates the feasi bility of prehospital thoracotomy and raises provocative issues regard ing future intense surgical involvement in prehospital care.