Re: Comparison of open and closed chest compressions after traumatic arrest

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In Reply:
We would like to address Dr. Seamon’s letter regarding our manuscript titled “Open Chest Cardiac Massage Offers No Benefit Over Closed Chest Compressions in Patients With Traumatic Cardiac Arrest.” Dr. Seamon raises some interesting points with regard to closed chest compressions (CCC) and open chest cardiac massage (OCCM) and appreciate his comments. We understand the limitations of our study and believe we addressed them appropriately in our paper. As this was purely an observational study, we were only able to report on the data we obtained. While we acknowledge the lack of physiologic variables in our study, we had near complete mortality, which makes it difficult to report physiology on dead patients. However, it is very important to note that end-tidal CO2 (ETCO2), per AHA guidelines, is the gold standard measure of resuscitative efforts, irrespective of ventilation and perfusion. Likewise, and equally important, we were simply stating that, based on our findings, OCCM is not superior to CCC, but not that CCC should replace OCCM. Perhaps the reason for this finding in our small data set is the time it takes to open the chest may be better served with continuous CCC. Furthermore, our interpretation of Mattox and Feliciano’s article from 1982 was that delay in prehospital care was the major cause of death, not that CCC had no clinical value as it was not found to be an independent predictor of mortality. Finally, we would also caution referencing controlled animal studies as valuable translational research and scientific fact.
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