Prospective study of blunt aortic injury: Multicenter Trial of the American Association for the Surgery of Trauma
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.; Bynoe, R.P.; Diamond, D.L.; Wall, M.; Gates, J.D.; Asensio, J.A.; Enderson, B.L.
Journal of Trauma 42(3): 374-80; Discussion 380-3
1997
ISSN/ISBN: 0022-5282 PMID: 9095103 Document Number: 469841
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 multicenter 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 gtoreq 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.