Why Is a “Traumatic Hemicorporectomy Incompatible With Life?

Question by Miranda P: Why is a “traumatic hemicorporectomy incompatible with life?
Traumatic hemicorporectomy or “body cut in half,” yeah the guy with bleed to death pretty quickly
BUT
If you get the guy to the ED quickly, you can alway do an ED thoracotomy, cross-clamp the aorta, transfuse type O blood and give crystalloids to restore the extracellular fluid deficit and start open chest cardiac massage. Get a pulse back and race the guy to the OR. Repair the damage.
If septic shock should manifest, give plenty of IV fluids (the basis in treatment of septic shock) broad spectrum antibiotics and presser agents (dopamine and norepinepherine) Have this guy in a drug induced coma until the injury heals.
Of course the severed spinal chord can not be repaired, however it is also NOT incompatible with life because the lesion will be bellow the C4 level, not affecting the phrenic nerve supplying the diaphragm and th intercostal muscle.
Question
Why do many doc’s consider a traumatic hemicorporectomy “incompatible with life” when as I explained above it is VERY MANAGEABLE??
I’m a doctor

Best answer:

Answer by 9Suns
I tend to disagree with your theory. Give me an example of ANY emergency room that would be able to facilitate all of the procedures you mention, and also have the staff available to dedicate to this ‘body cut in half”?

Many emergency rooms have protocols under which they will not resuscitate or support a patient who has already undergone a severe bisection injury that is essentially a de facto hemicorporectomy. This stance is largely due to very limited rates of survival. A study which cased 267 blunt and penetrating trauma patients (decapitation, hemicorporectomy, etc.) who had cardiopulmonary arrest found that only 7 survived long term, only four of whom returned to their previous neurologic level. Apart from the overwhelming statistical unlikelihood of survival, operative hemicorporectomy is unlikely to be successful unless the patient has the “sufficient emotional and psychological maturity to cope” and “sufficient determination and physical strength to undergo the intensive rehabilitation”.

Emergency rooms and ambulance services often release policy which prevents the resuscitation of such patients. The UK’s National Health Service, for example, in its “Policy and Procedures for the Recognition of Life Extinct” describes traumatic hemicorporectomy as “unequivocally associated with death” and that such injuries should be considered “incompatible with life”.The National Association of EMS Physicians (NAEMSP) and the American College of Surgeons Committee on Trauma (COT) have also released similar position statements and policy allowing on-scene personnel to determine such patients unresuscitatable.

Answer by ckm1956
Are you SURE you’re a doctor?

Every single Level I trauma center I’ve ever worked around (Portland Emmanuel to Yale) would laugh at this idea. In blunt trauma (such as this), dead is dead. If ANY blunt trauma patient arrests more than 5 minutes out from a Level I center, they’re dead. Period.

On the other hand, penetrating trauma (like a GSW) is much more survivable.

If you’re still convinced you’re right, propose a study to the American College of Surgeons.

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