Prospective study of blunt aortic injury: Multicenter trial of the American Association for the Surgery of Trauma

Timothy C. Fabian, J. David Richardson, Martin A. Croce, J. Stanley Smith, George Rodman, Paul A. Kearney, William Flynn, Arthur L. Ney, John B. Cone, Fred A. Luchette, David H. Wisner, Donald J. Scholten, Bonnie L. Beaver, Alasdair K. Conn, Robert Coscia, David B. Hoyt, John A. Morris, J. Duncan Harviel, Andrew B. Peitzman, Raymond P. BynoeDaniel L. Diamond, Matthew Wall, Jonathan D. Gates, Juan A. Asensio, Mary C. McCarthy, Murray J. Girotti, Mary VanWijngaarden, Thomas H. Cogbill, Marc A. Levison, Charles Aprahamian, John E. Sutton, C. F. Allen, Erwin F. Hirsch, Kimberly Nagy, Ben L. Bachulis, Charles R. Bales, Marc J. Shapiro, Michael H. Metzler, Vincent R. Conti, Christopher C. Baker, Michael P. Bannon, M. Gage Ochsner, Michael H. Thomason, Jonathan R. Hiatt, Keith F. O'Malley, Farouck N. Obeid, Perry Gray, Paul E. Bankey, M. Margaret Knudson, Donna Lynn Dyess, Blaine L. Enderson

Research output: Contribution to journalArticle

611 Scopus citations

Abstract

Background: Blunt aortic injury is a major cause of death from blunt trauma. Evolution of diagnostic techniques and methods of operative repair have altered the management and posed new questions in recent years. Methods: This study was a prospectively conducted multi-center trial involving 50 trauma centers in North America under the direction of the Multi- institutional Trial Committee of the American Association for the Surgery of Trauma. Results: There were 274 blunt aortic injury cases studied over 2.5 years, of which 81% were caused by automobile crashes. Chest computed tomography and transesophageal echocardiography were applied in 88 and 30 cases, respectively, and were 75 and 80% diagnostic, respectively. Two hundred seven stable patients underwent planned thoracotomy and repair. Clamp and sew technique was used in 73 (35%) and bypass techniques in 134 (65%). Overall mortality was 31%, with 63% of deaths being attributable to aortic rupture; mortality was not affected by method of repair. Paraplegia occurred postoperatively in 8.7%. Logistic regression analysis demonstrated clamp and sew (p = 0.002) and aortic cross clamp time of ≤30 minutes (p = 0.01) to be associated with development of postoperative paraplegia. Conclusions: Rupture after hospital admission remains a major problem. Although newer diagnostic techniques are being applied, at this time aortography remains the diagnostic standard. Aortic cross clamp time beyond 30 minutes was associated with paraplegia; bypass techniques, which provide distal aortic perfusion, produced significantly lower paraplegia rates than the clamp and sew approach.

Original languageEnglish (US)
Pages (from-to)374-382
Number of pages9
JournalJournal of Trauma - Injury, Infection and Critical Care
Volume42
Issue number3
DOIs
StatePublished - Mar 1 1997

Keywords

  • Blunt aortic injury
  • management

ASJC Scopus subject areas

  • Surgery
  • Critical Care and Intensive Care Medicine

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    Fabian, T. C., Richardson, J. D., Croce, M. A., Smith, J. S., Rodman, G., Kearney, P. A., Flynn, W., Ney, A. L., Cone, J. B., Luchette, F. A., Wisner, D. H., Scholten, D. J., Beaver, B. L., Conn, A. K., Coscia, R., Hoyt, D. B., Morris, J. A., Harviel, J. D., Peitzman, A. B., ... Enderson, B. L. (1997). Prospective study of blunt aortic injury: Multicenter trial of the American Association for the Surgery of Trauma. Journal of Trauma - Injury, Infection and Critical Care, 42(3), 374-382. https://doi.org/10.1097/00005373-199703000-00003