@entity341 ( XXXX ). A 26-month experience using an "agonal" protocol.

@entity1 @entity18329 @entity341 @entity1003 @entity1913 @entity130
@entity341 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 @entity341 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 @entity1 (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 @entity1 was successfully resuscitated from @entity1913 with @entity341 . Three additional @entity1 had "signs of life" restored (one pediatric blunt; two @entity18329 ) but died of @entity1003 shortly thereafter. The experience with air ambulance @entity1 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 @entity1 will be arriving at @entity130 centers with no vital signs and @entity1913 but only moments from the accident. This special group of "dying" @entity1 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 @entity1 who can benefit and elimination of those @entity1 where @entity341 would be useless. The primary benefactor for @entity341 remains the @entity1 sustaining a stab wound to the heart who arrives at the center shortly after injury. In other areas, such as abdominal exsanguination or severe @entity1913 , further study is needed to determine what factors, prehospital and resuscitative, will improve outcome.
