Outcome of trauma patients who present to the operating room with hypotension.

The case records of 101 patients with trauma who presented to the operating room (OR) for emergency surgery and had a systolic blood pressure (sBP) less than 90 mm Hg over a period of 3 years were reviewed. The sBP was 70-89 mm Hg in 47 patients, 50-69 mm Hg in 19 patients, and unobtainable in 35 patients. The mortality rates for these three groups were 6 per cent, 79 per cent, and 86 per cent, respectively. The increase in mortality rate with a sBP less than 70 mm Hg was highly significant (p less than 0.001). The duration of initial shock in the OR and emergency department (ED) exceeded 30 minutes in 56 patients, and 35 patients (62%) died. In contrast, of 45 patients who had less than 30 minutes of shock, only 13 patients (29%) died (p less than 0.001). Of the 54 patients who presented to the OR with a sBP less than 70 mm Hg, 42 patients had early cross-clamping of the thoracic aorta. This was performed as a prelaparatomy thoracotomy in 25 patients with abdominal injuries and as part of the thoracotomy in 17 patients with chest trauma. Nineteen (45%) of these 42 patients responded favorably to aortic cross-clamping with a sustained increase in sBP to greater than 90 mm Hg within 5 minutes. Of these 19 patients, 42 per cent survived. The 23 patients who did not respond to aortic cross-clamping died in the OR.(ABSTRACT TRUNCATED AT 250 WORDS)