Surgery in the resuscitation of critically injured patients

Immediate surgery is essential to resuscitate and save 5% to 10% of those suffering life-threatening trauma. Recently, emergency room surgery has been proposed as the procedure to follow in stabilizing such patients. Over a 3-year period, 41 moribund patients were treated by the trauma service at the Health Sciences Centre in Winnipeg. All were managed in the main operating theatre following a "crash protocol" for immediate surgery. Twenty-three patients arrived in cardiac arrest or with an unrecordable blood pressure; of these, 4 (17%) survived. Eighteen patients had a blood pressure of 70 mm Hg systolic or less and failed to respond to massive O positive blood transfusion; of these, 14 (77%) survived. The mix of mode of injury and injury severity scoring is important to compare results from within and between centres. The author's experience indicates that the use of a high-priority crash protocol for managing moribund patients with life-threatening traumatic injury in the main operating room provides a standard of care equal to or better than that reported for emergency room surgery.