Schwab C W, Adcock O T, Max M H
Am Surg. 1986 Jan;52(1):20-9.
EDT can be successfully performed with the proper system in place. This includes an established thoracotomy protocol, a well-integrated EMS system, and an in-house team. Time seems to be critical, and the time between injury and EDT may be the single most important factor affecting survival other than the mechanism of injury. Cardiac penetrations, especially stab wounds, were found to have a 93 per cent survival while subdiaphragmatic penetrations had only one survivor from a group of 18 patients (5.5%). The high rate of salvage in the heart wound group probably reflects the speed of prehospital transport, though all other major series have found this group to gain the maximum benefit. No patient was successfully resuscitated from blunt injury with EDT. Three additional patients had "signs of life" restored (one pediatric blunt; two subdiaphragmatic gunshot wounds) but died of coagulopathies shortly thereafter. The experience with air ambulance patients was far too small to allow any conclusions or observations. It is felt that as the use and application of helicopters to EMS situations becomes widespread, more patients will be arriving at trauma centers with no vital signs and massive blunt injury but only moments from the accident. This special group of "dying" patients will require intense scrutiny and possibly new and inventive approaches for any hopeful salvage. Emergency thoracotomy will, no doubt, have a place as part of this. The development of a simple working protocol is of extreme importance. The protocol should be one that will allow maximum selection of patients who can benefit and elimination of those patients where EDT would be useless. The primary benefactor for EDT remains the patient sustaining a stab wound to the heart who arrives at the center shortly after injury. In other areas, such as abdominal exsanguination or severe blunt injury, further study is needed to determine what factors, prehospital and resuscitative, will improve outcome.
在具备合适系统的情况下，急诊开胸手术（EDT）能够成功实施。这包括既定的开胸手术方案、完善整合的紧急医疗服务（EMS）系统以及医院内部团队。时间似乎至关重要，受伤与实施EDT之间的时间可能是除损伤机制外影响生存的唯一最重要因素。发现心脏穿透伤，尤其是刺伤，生存率为93%，而膈下穿透伤在18例患者中仅有1例存活（5.5%）。心脏伤口组的高挽救率可能反映了院前转运的速度，不过所有其他主要系列研究都发现该组获益最大。没有患者通过EDT从钝性损伤中成功复苏。另外3例患者恢复了“生命迹象”（1例小儿钝性伤；2例膈下枪伤），但随后不久死于凝血功能障碍。空中救护患者的经验太少，无法得出任何结论或观察结果。人们认为，随着直升机在EMS情况中的使用和应用变得广泛，更多无生命体征且有严重钝性损伤的患者将在事故发生后不久抵达创伤中心。这一特殊的“濒死”患者群体将需要严格审查，可能还需要新的创新方法来实现任何有望的挽救。毫无疑问，急诊开胸手术将作为其中一部分发挥作用。制定一个简单可行的方案极为重要。该方案应能最大程度地筛选出可能获益的患者，并排除那些EDT无用的患者。EDT的主要受益者仍然是受伤后不久抵达中心的心脏刺伤患者。在其他领域，如腹部大出血或严重钝性损伤，需要进一步研究以确定哪些院前和复苏因素将改善预后。
