Intact survival from a blunt trauma cardiac arrest using intraoperative automated CPR.

Survival following a blunt traumatic cardiac arrest is rare. Current guidelines suggest that a resuscitative thoracotomy may be performed under specific circumstances. This approach is almost always futile. Technology such as reliable point of care ultrasound and automated compression devices may allow surgeons to consider a damage control laparotomy as the initial surgical approach in blunt trauma cardiac arrest when the point of care ultrasound is positive for intraabdominal injury and there is low suspicion of an unstable intrathoracic injury. Here we present what we believe to be the first reported successful resuscitation of a patient who suffered a blunt trauma cardiac arrest utilizing an automated CPR device before and during an exploratory damage control laparotomy. Despite severe trauma this patient was discharged home, neurologically intact. We believe this case may support the use of automated CPR in the setting of blunt trauma cardiac arrest in patients, assuming the patient has a negative point of care ultrasound for intrathoracic injury, a positive point of care ultrasound for intraperitoneal hemorrhage, and is receiving vigorous blood product administration.

Hemorrhage associated with vitamin C deficiency in surgical patients.

BACKGROUND: Diffuse hemorrhage in surgical patients with normal coagulation parameters may be caused by vitamin C deficiency and is rapidly reversed by vitamin C replacement. METHODS: Patients treated on a surgical service were entered into a clinical registry over a 12-month period if they experienced diffuse hemorrhage in the face of normal coagulation parameters and a plasma ascorbic acid level < 0.6 mg/dL (normal 0.6-2.0 mg/dL). Oral vitamin C replacement was administered after determination of plasma ascorbic acid level. Response to therapy, including subsequent bleeding events, need for blood transfusions, and demographic data including social and dietary history were retrospectively reviewed from hospital and outpatient clinic records. RESULTS: Twelve patients with bleeding diatheses and low plasma ascorbic acid levels were identified. Plasma ascorbic acid levels were 0.1 to 0.5 mg/dL (mean, 0.3 mg/dL). There were 6 men and 6 women; age ranged from 46 to 90 years (mean, 78 years). Coagulation parameters were normal in all patients. Diffuse postoperative bleeding from nonsurgical causes was evident in 10 of 12 patients. Four patients, 2 of whom had operations, presented with chronic recurrent blood loss from the gastrointestinal tract. Each patient received 250 to 1000 mg of vitamin C replacement daily. Within 24 hours of vitamin C administration, there was no further evidence of clinical bleeding nor need for subsequent blood transfusions in any patient. CONCLUSIONS: Vitamin C deficiency should be included in the differential diagnosis of nonspecific bleeding in surgical patients. Prolonged hospitalization, severe illness, and poor diet create vitamin C deficiency with significant clinical consequences. Oral vitamin C replacement rapidly reverses the effects of this disorder.

Obesity: is there an increase in perioperative complications in those undergoing elective colon and rectal resection for carcinoma?

The hypothesis of this study was that obese and overweight patients undergoing elective resection for colon and rectal cancer have longer operative times, increased intraoperative blood loss, and more postoperative complications compared with normal-weight individuals. Our study cohorts included all patients undergoing elective first-time colon resection for proven colorectal carcinoma. Patients undergoing resection for recurrent disease or for emergent indications such as obstruction, perforation, or hemorrhage and those who underwent an additional surgical procedure at the time of colon resection were excluded from analysis. We conducted a retrospective chart review of all patients undergoing resection for colorectal carcinoma during a 30-month period. One hundred fifty-three consecutive patients were identified. Body Mass Index was calculated for each patient. Each patient was labeled as normal, overweight, or obese on the basis of World Health Organization criteria. Estimated intraoperative blood loss, duration of surgery, and postoperative complications were recorded for each patient. Comparisons of continuous variables were made using one- or two-way analysis of variance testing. Comparisons of discrete variables were made with chi-square testing. Level of confidence was defined as P < 0.05. Forty-eight normal, 54 overweight, and 51 obese patients were identified. The type of colon resection, age range, and premorbid conditions were well matched between groups. There was no statistical difference in intraoperative blood loss between groups. The operative times were statistically longer in obese and overweight groups compared with the normal group. No statistical differences existed in postoperative complications between groups. We conclude that obese and overweight patients undergoing resection for colorectal carcinoma when compared with normal-weight patients have similar intraoperative blood loss and postoperative complications but longer operative times.