Crush injuries of the chest. An historical perspective in a single unit.

The management of crushed chest injuries in the 1950s was unsatisfactory. A survey of these injuries in south-east Scotland in 1955-60 showed a mortality of 76%. The introduction of intermittent positive pressure ventilation carried out in a special unit produced a dramatic improvement in outcome with mortality reduced to 16% in a reported series in 1961-65. Two further similar series of crushed chest injuries treated in the same unit in 1977-81 and 1988-91 are now described. Overall mortality rates have remained the same at 17% and 16%. Details of injuries, management and causes of death are given. It is concluded that intermittent positive pressure ventilation remains the mainstay of treatment and that further improvement in results will be difficult to obtain.