[Thoracic injuries--when is use of the heart-lung machine necessary?]

Most patients with severe blunt or penetrating thoracic injuries die early after the accident (approximately 50%). The majority of those who reach an emergency department (approximately 80-85%) can therefore be treated initially with intensive observation (following drainage and/or intubation). If clinical deterioration due to continuous bleeding or progressive hemodynamic and respiratory problems occurs, however, urgent surgical intervention is indicated. Transfer of those critical patients to specialized hospitals often becomes dangerous because of time loss, and it is unnecessary as major equipment (e.g., extracorporeal circulation) is demanded only in the minority of operations.