Does Clamshell Thoracotomy Better Facilitate Thoracic Life-Saving Procedures Without Increased Complication Compared with an Anterolateral Approach to Resuscitative Thoracotomy? Results from the American Association for the Surgery of Trauma Aortic Occlusion for Resuscitation in Trauma and Acute Care Surgery Registry
| Autor: | Laura J. Moore, Kathryn Johnson, Jeannette G. Ward, John K. Bini, Timothy W. Wolff, Robert M. Madayag, Thomas M. Scalea, Nicole Cornell, Alice Piccinini, Forrest 'Dell' Moore, Chad J. Richardson, Zhengwen Xiao, Yohan Diaz Zuniga, David Turay, Valorie L. Baggenstoss, Matthew Yanoff, Xian Luo-Owen, Ernest E. Moore, David V. Feliciano, Stephanie Gordy, Reagan Bollig, Rachele Solomon, Brian J. Daley, Mark J. Seamon, Jonathan J. Morrison, Joseph A Ibrahim, Juan C. Quispe, Jeanette M. Podbielski, Chance Spalding, Elizabeth Warnack, Nathaniel Poulin, Catherine Rauschendorfer, John H. Matsuura, Jennifer Knight, Joseph Farhat, Marko Bukur, Joshua Pringle, John B. Holcomb, Karen Herzing, Joseph J. DuBose, Derek Lumbard, David Skarupa, Chad G. Ball, Kailey Nolan, Jeremy W. Cannon, Andrew W. Kirkpatrick, Kenji Inaba, Jennifer Mull, Rachel M. Nygaard, Matthew B. Bloom, Elizabeth Dauer, Dafney Davare, Nam T. Tran, Seong Lee, Karen Safcsak, Eileen M. Bulger, Niki Rasnake, David S. Kauvar, William A. Teeter, Charles J. Fox, Pamela Bourg |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male Resuscitation medicine.medical_specialty medicine.medical_treatment 03 medical and health sciences 0302 clinical medicine Interquartile range medicine.artery Humans Medicine Registries Thoracotomy Aorta Lung Resuscitative thoracotomy business.industry Balloon Occlusion Survival Analysis Surgery medicine.anatomical_structure 030220 oncology & carcinogenesis Wounds and Injuries Injury Severity Score Female 030211 gastroenterology & hepatology business Complication |
| Zdroj: | Journal of the American College of Surgeons. 231:713-719e1 |
| ISSN: | 1072-7515 |
| DOI: | 10.1016/j.jamcollsurg.2020.09.002 |
| Popis: | Background Resuscitative thoracotomy (RT) is life-saving in select patients and can be accomplished through a left anterolateral (AT) or clamshell thoracotomy (CT). CT may provide additional exposure, facilitating certain operative procedures, but the added blood and heat loss and time to perform it may increase complications. No prospective multicenter comparison of techniques has yet been reported. Study Design The observational AAST Aortic Occlusion for Resuscitation in Trauma and Acute care surgery (AORTA) registry was used to compare AT and CT in RT. Results AORTA recorded 1,218 RTs at 46 trauma centers from June 2014 to January 2020. Overall survival after RT was 6.0% (AT 6.6%; [59 of 900]; CT 4.2% [13 of 296], p = 0.132). Among all RTs, 11.1% (142 of 1,278) surviving at least 24 hours were used tocompare AT (112) and CT (30). There was no difference between the 2 groups withregard to age, sex, Injury Severity Score, or mechanism of injury (Table 1). CT was significantly more likely to be used in patients needing resection of the lung or cardiac repair. CT was not associated with increased local thoracic/systemic complications, higher transfusion requirement, or greater ventilator, ICU, or hospital days compared with AT. Conclusions Clamshell thoracotomy facilitates thoracic life-saving procedures withoutincreased systemic or thoracic complications compared with AT in patients undergoing RT. |
| Databáze: | OpenAIRE |
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