ER Thoracotomy for Medical Arrest

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huh?

Charles Brault <c_brault at yahoo.com> wrote:If their was some clinical statistic truth to what your are
saying
You would have thought that the Theracardia
Would have triumfolly failled this ominous gap ?

Charles

--- Don Benson wrote:

> I believe the more controversial subject is the role of
> thoracotomy and open
> chest CPR in medical arrest. 
> 
> Almost 10 years ago, I was faced with the case of an 11
> year old lad who got
> in an argument with his folks on Thanksgiving and
> proceeded to the basement
> where he hung himself from the rafters. He arrived in the
> ED after an
> unknown downtime (no more than 20 minutes) and was
> asystolic. After about 15
> minutes of closed chest CPR and with tears in my eyes, I
> opened his chest to
> perform cardiac massage. He began fibrillating within a
> minute, and I
> successfully shocked him into sinus rhythm. He labored
> for days in the ICU
> with some brainstem activity but eventually was
> pronounced brain dead and
> some of his organs were harvested. The pediatric surgeon
> was furious with
> me, to say the least. My take on it was that I waited too
> long. Who knows.
> 
> This event sent me back to the lab for one last time
> where my colleagues and
> I look at our canine cousins in 2 groups: 5 minutes of
> arrest followed by
> closed chest CPR/ACLS for 15 minutes then defibrillation,
> and 5 minutes of
> arrest followed by open chest CPR/ACLS for 15 minutes
> followed by
> defibrillation. After randomly assigning animals to
> groups, I stopped the
> study with 7 CC-CPR and 5 OC-CPR subject because the
> results were so
> impressive. All of the open chest animals were easy to
> defibrillate and
> resuscitate, and were normal both behaviorally and
> histologically (stained
> brain was looked at by neuropathologists). All of the
> closed chest dogs were
> either unable to be resuscitated or had severe neurologic
> deficits. [Benson
> DM, O'Neil BO, Kakish E, Erpelding J, et al: Open chest
> CPR improves
> survival and neurologic outcome following cardiac arrest.
> RESUSCITATION
> 2005; 64: 209-217.]
> 
> I won't do it again (hospital politics), unless it is one
> of my own children
> or the President. I strongly believe that if a patient
> suffers an arrest
> from an etiology that deems them potentially salvageable
> (young,
> hyperkalemic, hypothermic, certain poisonings, ad
> nauseum) that open chest
> CPR is the best therapy.
> 
> What say you?
> 
> Don Benson, DO, FACEP
> St. John Hospital
> Detroit
> bensonblues at comcast.net
> 
> 
> -----Original Message-----
> From: trauma-list-bounces at trauma.org
> [mailto:trauma-list-bounces at trauma.org]
> On Behalf Of trauma-list-request at trauma.org
> Sent: Tuesday, November 01, 2005 7:00 AM
> To: trauma-list at trauma.org
> Subject: trauma-list Digest, Vol 29, Issue 1
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