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Editor,—I really wonder about the value of Dr Calinas-Correia's1 article on thoracotomy and internal cardiac massage for non-shockable arrested patients. It seems to me that the study only proved the futility of attempting resuscitation this way on these patients. Thoracotomy and internal cardiac massage have a place in the moribund patient with a tamponade and/or penetrating heart wound but this is gung-ho in asystole. The ALS algorhythm of early BLS and early ALS must remain the mainstay of attempts to salvage these patients with their universally poor prognosis.
Editor,—Dr Kennedy seems satisfied with what he describes as the “universally poor prognosis” of patients in non-shockable cardiac arrest, and clearly defends the unquestioned maintenance of the management that achieves that same outlook. The rationale for investigating open chest cardiac massage has been presented within the paper. The indications Dr Kennedy recognises are just some of those accepted by those investigating cardiopulmonary resuscitation.1–3 Our study presents seven patients, and to take it as proof of efficacy or futility is obviously inappropriate. However, the presentation of data collected under a realistic scenario of cardiopulmonary resuscitation is important to allow the discussion regarding the feasibility and usefulness of further research. What remains of foremost importance is that no study showed worse outcomes with thoracotomy than with closed chest compressions in this group of patients, in fact the results have been slightly better with open chest cardiac massage, even if the significance is far from established.4–13 Therefore, the use of thoracotomy remains a matter for further investigation, and a priori dismissive verdict seems more of an aesthetic nature than evidence based. The very short times from thoracotomy to ROSC in three of seven patients that we present should encourage further research, as they corroborate the experimental data on the better coronary perfusion obtained with this technique.5, 6
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