• Joseph J DuBose, Jonathan Morrison, Laura J Moore, Jeremy W Cannon, Mark J Seamon, Kenji Inaba, Charles J Fox, Ernest E Moore, David V Feliciano, Thomas Scalea, and AAST AORTA Study Group.
• Department of Surgery, R Adams Cowley Shock Trauma Center, University of Maryland Medical System, Baltimore, MD. Electronic address: joseph.dubose@umm.edu.
• J. Am. Coll. Surg. 2020 Dec 1; 231 (6): 713-719.e1.

BackgroundResuscitative 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 DesignThe observational AAST Aortic Occlusion for Resuscitation in Trauma and Acute care surgery (AORTA) registry was used to compare AT and CT in RT.ResultsAORTA 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.ConclusionsClamshell thoracotomy facilitates thoracic life-saving procedures withoutincreased systemic or thoracic complications compared with AT in patients undergoing RT.Published by Elsevier Inc.

24 keywords...

hide…