Emergency Room Thoracotomy for Penetrating Cardiac Injuries

Rohman, Michael; Ivatury, Rao R.; Steichen, Felicien M.; Gaudino, Jean; Khan, Mohammad; Stahl, William M.

doi:10.1097/00005373-198207000-00153

Cited by 4 publications

(6 citation statements)

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“…If this period is exceeded, successful restoration of a normal sinus rhythm is generally not possible. The authors' personal experiences validates this safety period (Millham and Grindlinger, 1919;Coimbra et al, 1921;Ivatury et al 1981Ivatury et al , 1987Gervin and Fischer, 1982;Bodai et al, 1983;Rohman et al, 1983;Mattox et al, 1985;Demetriades et al, 1990;Esposito et al, 1991;Durham et al, 1992;Lorenz et al, 1992;Asensio et al, 1996).…”

Section: Adjunct Manoeuvressupporting

confidence: 62%

“…This incision allows full exposure of the anterior mediastinum and both hemithoracic cavities. It is important to note that on transection of the sternum, both internal mammary arteries are sacrificed and must be ligated at the completion of the procedure (Asensio et al, 1996;Ivatury et al, 1981;Gervin and Fischer, 1982;Bodai et al, 1983;Rohman et al, 1983). …”

Section: Incisionsmentioning

confidence: 99%

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Cardiac trauma

Asensio

Roldán

Petrone

et al. 2001

Trauma

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The first description of a cardiac injury is found in The Iliad. Cardiac injuries are one of the most challenging injuries, requiring immediate surgical intervention, excellent surgical skills and critical care. The clinical presentation of penetrating cardiac injuries has a broad range, from haemodynamic stability to cardiopulmonary arrest. Two-dimensional echocardiography is now the procedure of choice over subxiphoid pericardial window to evaluate for the presence of these injuries. Emergency department thoracotomy is indicated for management of penetrating cardiac injuries with immediate cardiography, aortic cross-clamping and open cardiac massage. The left anterolateral thoracotomy is the incision of choice for patients that arrive in extremis. The repair of the wounds should be performed according to the anatomy of the injured area. Mortality remains high, although better patient selection according to physiologic scoring leads to increase in survival.

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Section: Adjunct Manoeuvressupporting

confidence: 62%

Section: Incisionsmentioning

confidence: 99%

Cardiac trauma

Asensio

Roldán

Petrone

et al. 2001

Trauma

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“…Emergent thoracotomy was performed in all patients with any of the following clinical presentations: agonal (25); hypotensive, non-responding; hypotensive, transiently responding; and initially managed with a chest tube that drained more than 1500cc upon insertion or more than 200cc blood/hour for more than three hours.…”

Section: Patient Selectionmentioning

confidence: 99%

Damage-control techniques in the management of severe lung trauma

García

Martı́nez

Rodríguez

et al. 2015

Journal of Trauma and Acute Care Surgery

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Background Damage Control (DC) has improved survival from severe abdominal and extremities injuries. The data on the surgical strategies and outcomes in patients managed with DC for severe thoracic injuries is scarce. Methods Retrospective review of the patients treated with DC for thoracic/pulmonary complex trauma at two level I trauma centers from 2006 to 2010. Subjects 14 and older, were included. Demographics, trauma characteristics, surgical techniques, and resuscitation strategies were reviewed. Results A total of 840 trauma thoracotomies were performed. Damage control thoracotomy (DCT) was done in 31 (3.7%). Pulmonary trauma was found in 25 of them. The median age was 28 (IQR 20–34) years, Revised Trauma Score was 7.11, (IQR 5.44–7.55), and Injury Severity Score was 26 (IQR 25–41). Nineteen patients had gunshot-wounds, four stab-wounds and two blunt trauma. Pulmonary trauma was managed by pneumorrhaphy in three cases, tractotomy in 12, wedge resection in one and packing as primary treatment in 8. Clamping of the pulmonary hilum was used as a last resource in 7 cases. Five patients returned to the ICU with the pulmonary hilum occluded by a vascular clamp or an en masse ligature. These patients underwent a deferred resection within 16 to 90 hours after the initial DCT. Four of them survived. Bleeding from other intra-thoracic sources was found in 20 cases: major vessels in nine, heart in three, and thoracic wall in nine. DCT mortality in pulmonary trauma was 6/25, (24%) due to coagulopathy or persistent bleeding in five cases and to multiorgan failure in one. Conclusion This series describes our experience with DCT in severe lung trauma. We describe pulmonary hilum clamping and deferred lung resection as a viable surgical alternative for major pulmonary injuries, and the use of packing as a definitive method for hemorrhage control.

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“…Si este período de tiempo es excedido, una restauración de un ritmo sinusal normal generalmente no es posible. [11][12][13][14][15][16][17][18][19][20][21][22][23] Otra valiosa maniobra es el Clampeo del Hilio Pulmonar, el cual está indicado para el manejo de lesión pulmonar asociada con una rápida e incohersible hemorragia. Esta maniobra tiene por propósito contrarrestar la hemorragia pulmonar y prevenir una embolia aérea.…”

Section: Técnicas De Reparación De Daño Cardíacounclassified