Surgical treatment of emergencies of the heart and vessels in the thorax.

Of all the emergencies affecting the heart, cardiac arrest requires the most urgent treatment. Anoxia, vagal stimulation, anesthetic agents, unexpected reactions to drugs, and manipulation and displacement of the heart have been shown to be at fault, but frequently no apparent reason can be found. 1 Failure to recognize and successfully treat cardiac standstill or fibrillation within three to five minutes will usually, at best, result in permanent central nervous system changes. 2 Experience has shown that too often it is wasted effort to rely on the administration of cardiac stimulants through the intact thoracic wall. If this method has been tried and no perceptible return of cardiac function is apparent in a minute, one should waste no more time but proceed with thoracotomy through the left fourth interspace, cutting costal cartilages to gain exposure. Oxygen should be administered, preferably through an intratracheal tube; but, until the tube is in