Journal of the American College of Surgeons
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Documented prehospital asystole justifies termination of resuscitation, but recently it has been proposed to extend this policy to patients in the field with pulseless electrical activity. Consequently, we questioned whether resuscitative thoracotomy is warranted in the critically injured patient who fails to respond to prehospital CPR. ⋯ EDT after prehospital CPR can be used to salvage select critically injured patients. Based on these data, we propose that resuscitative thoracotomy is futile care in patients with blunt trauma requiring prehospital CPR longer than 5 minutes, and in patients with penetrating trauma with more than 15 minutes of prehospital CPR. EDT is warranted in those patients with penetrating trauma with less than 15 minutes of prehospital CPR, and should be performed despite documented asystole on arrival if pericardial tamponade is the proximate event.
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Dwindling operative opportunities in trauma care may have a detrimental impact on career satisfaction among trauma surgeons and on career attractiveness to surgical trainees. Addition of emergency general surgery may alleviate some of these concerns. ⋯ The combined trauma and nontrauma surgery service increased operative caseloads and improved satisfaction of trauma surgeons. A comprehensive trauma and emergency general surgery service may be an attractive model for the future of trauma surgery and provide logistical and medical advantages to the emergency general surgery patient population.
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Comparative Study
Off-pump versus on-pump coronary artery bypass surgery: does the pump influence outcome?
This study assessed hospitalization outcome differences for patients undergoing off-pump coronary artery bypass (OPCAB) grafting compared with patients having coronary artery bypass grafting with cardiopulmonary bypass. ⋯ Patients undergoing OPCAB had a considerably shorter length of hospitalization, had fewer pulmonary and intraoperative complications, and received a lower volume of blood products.