The Annals of thoracic surgery
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Choice of a route of cannulation for intraaortic balloon counterpulsation during cardiopulmonary bypass is related to accessibility. In those patients in whom it is impossible to pass the intraaortic balloon pump (IABP) into the common femoral artery, ascending aortic cannulation is a rapid and direct method of insertion. ⋯ A technique is described for insertion of the IABP using a polytetrafluoroethylene (Impra) graft and closed-chest decannulation. Although considerable morbidity and mortality are associated with ascending aortic cannulation, it is simple, fast, and effective, and should be considered for all patients requiring postoperative IABP support in whom peripheral vascular disease makes access difficult.
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Clinical and laboratory experience with circulating lupus anticoagulant in 3 patients undergoing coronary artery bypass procedures is reported. This circulatory anticoagulant inhibits activation of prothrombin by the prothrombin activator complex (factor Xa, factor V, and phospholipid). ⋯ The lupus anticoagulant is a rare cause of bleeding after open-heart surgery. It appears to be a problem only when an additional coagulation defect is present.
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The effectiveness of aggressive resuscitation and early surgical intervention is evaluated in 1,992 casualties with thoracic battle wounds in Lebanon. The mechanism of injury was mainly high-velocity missiles and shelling in city battles. Ninety-seven percent of the wounds were penetrating. ⋯ Survival was 87% among 54 patients with great vessel wounds. Life salvage in 726 (36%) patients was documented to result from early open procedures. Other benefits of this approach are presented in this broad-based study.
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The case records of 200 patients who had emergency thoracotomy for penetrating trauma were reviewed. The mortality was 47% (93/200) for the entire series, 27% (21/79) for stab wounds and 60% (72/121) for gunshot wounds. Of 55 patients who underwent thoracotomy in the emergency department, 8 (15%) survived. ⋯ For those who had an OR thoracotomy for aortic cross-clamping because of abdominal injuries, survival was only 17% (5/30). Early thoracotomy has a place in the management of patients who have cardiac arrest in the ambulance or emergency department because of penetrating chest, neck, or extremity injuries, especially if caused by stab wounds. Cross-clamping of the thoracic aorta for massive abdominal bleeding should be applied selectively.