DEATH IN THE OPERATING-ROOM - AN ANALYSIS OF A MULTICENTER EXPERIENCE

To characterize causes of death in the operating room (OR) following m ajor trauma, a retrospective review of admissions to eight academic tr auma centers was conducted to define the etiology of death and challen ges for improvement in outcome. Five hundred thirty seven OR deaths of 72,151 admissions were reviewed for mechanism of injury, physiologic findings, resuscitation, patterns of injury, surgical procedures, caus e of death, and preventability. Blunt injuries accounted for 61% of al l injuries, gunshot wounds (GSW) accounted for 74% of penetrating inju ries. Sixty two percent of all patients arrived in shock. Average bloo d pressure (BP) was 52 mm Hg at the scene and 60 mm Hg on admission, w ith the period of shock > 10 minutes in 74%. Only 56% were resuscitate d to a BP > 90 mm Hg before surgery. Average time to the OR was 30.1 m inutes and mean best postresuscitation pH was 7.18. Mean best OR tempe rature was 32.2 degrees C. Recurrent injury patterns judged as the pri mary cause of patient death included head/neck injury (16.4%), chest i njury (27.4%), acid abdominal injury (53.4%). Actual cause of death wa s bleeding (82%), cerebral herniation (14.5%), and air emboli (2.2%). A different strategy for improved outcome was identified in 54 patient s with the following conclusions: (1) delayed transfer to the OR remai ns a problem with significant BP deterioration during delay, particula rly following interfacility transfer; (2) staged injury isolation and repair to allow better resuscitation and warming may lead to improved results; (3) combined thoracoabdominal injuries, particularly with tho racic aortic disruption, often require a different sequence of managem ent; (4) aggressive evaluation of retroperitoneal hematomas is essenti al; (5) OR management of severe liver injuries remains a technical cha llenge with better endpoints for packing needed; and (6) resuscitative thoracotomy applied to OR patients in extremis from exsanguination of fers little.