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London's Air Ambulance - Open Chest Surgery

Posted: Wed Oct 09, 2013 10:39 am
by Ryan
An great promotion of pre-hospital open surgery. I thought I'd share. It reminds me of moments recently in Afghanistan where field appendectomies were performed, obviously either under physician oversight or telemedicine. Very interesting read.

Thoracotomy, or open heart surgery, is usually only performed by a cardiothoracic surgeon in an operating theatre. In 1993, London’s Air Ambulance was the first medical service in the world to perform this emergency procedure at the scene of injury and save a patient’s life. Since London’s Air Ambulance’s pioneering advance, thoracotomy has been adopted by many other air ambulances and has saved lives worldwide.

A thoracotomy is a procedure which London’s Air Ambulance typically uses when there has been a penetrating injury to the chest, such as a stabbing, shooting or accidental impalement. Sadly, the prevalence of violent crime in London creates an ongoing requirement for this procedure and London’s Air Ambulance remains a world leader in terms of experience and success with thoracotomy. The service, which performs an average of two a month, is now experiencing a long term survival rate of 18% in patients who would otherwise be clinically dead as a result of this type of injury.

A typical injury that may require a thoracotomy would be where a patient has a wound to the chest that has injured the muscle of the heart. Bleeding from the wound causes a clot which compresses the heart and stops it from beating. This is known as a cardiac tamponade and can happen in a matter of minutes. The heart will stop and a cardiac arrest will happen, causing the patient to stop breathing. In this situation, normal resuscitation methods will not fix the problem – patients just would not survive.

The brain will take around 10 minutes to die if starved of blood. However with the help of the helicopter and the rapid response cars, the London’s Air Ambulance medical team can be on scene with the patient within this period and can perform a thoracotomy. Seconds can make a difference.

The thoracotomy performed by the doctor and paramedic involves making two incisions either side of the chest, using a scalpel cut to join the two incisions and opening the chest to gain access to the heart. The Doctor will then be able to assess what injury has caused the heart to stop and will act accordingly. If there is a puncture to the heart, they may need to sew it up and then may either inject adrenaline directly into the heart or have to perform internal cardiac massage to get the heart started again. Once the heart has restarted, London’s Air Ambulance can alert the trauma hospital to have a cardiothoracic surgeon standing by with the trauma team when the patient arrives.

To maximize the efficiency and safety of the emergency thoracotomy at the scene of injury, London’s Air Ambulance has adapted this procedure and simplified the process. A specific and demanding training regime allows this life-saving procedure to be performed by all London’s Air Ambulance doctors and paramedics.


Re: London's Air Ambulance - Open Chest Surgery

Posted: Fri Jan 03, 2014 1:50 am
by Ryan